MEDICARE: DR. MOHAMED T ISMAIL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	MD073821L	PA

General Provider Information

NPI Number	:	1053374892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMED T ISMAIL MD

Provider Business Mailing Address
First Line	:	1601 KIRKWOOD HWY
Second Line	:	VA WILMINGTON HOSPITAL
City	:	WILMINGTON
State	:	DE
Zip	:	19805-4917
Country	:	US
Telephone Number	:	302-633-5382
Fax Number	:	302-633-5589

Provider Business Practice Location Address
First Line	:	1601 KIRKWOOD HWY
Second Line	:	VA WILMINGTON HOSPITAL
City	:	WILMINGTON
State	:	DE
Zip	:	19805-4917
Country	:	US
Telephone Number	:	302-633-5382
Fax Number	:	302-633-5589

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	07/08/2007

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