Healthcare Provider Details

I. General information

NPI: 1679661102
Provider Name (Legal Business Name): MAGDI TAGELDIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7626 SPANISH FORT BLVD
SPANISH FORT AL
36527-5376
US

IV. Provider business mailing address

7626 SPANISH FORT BLVD
SPANISH FORT AL
36527-5376
US

V. Phone/Fax

Practice location:
  • Phone: 251-288-2750
  • Fax: 251-586-8599
Mailing address:
  • Phone: 251-288-2750
  • Fax: 251-586-8599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number29986
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME115308
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberME115308
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number29986
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: