Healthcare Provider Details

I. General information

NPI: 1164155818
Provider Name (Legal Business Name): MOHAMED MAHER FATHY MOSTAFA ABDELFATTAH M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 GEORGIA AVENUE, NW, HOWARD UNIVERSITY HOSPITAL
WASHINGTON DC
20060
US

IV. Provider business mailing address

8964 15TH AVE
BROOKLYN NY
11228-3902
US

V. Phone/Fax

Practice location:
  • Phone: 202-865-6100
  • Fax: 202-745-3731
Mailing address:
  • Phone: 718-751-6008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number96013
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: