Healthcare Provider Details

I. General information

NPI: 1053374892
Provider Name (Legal Business Name): MOHAMED T ISMAIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 KIRKWOOD HWY VA WILMINGTON HOSPITAL
WILMINGTON DE
19805-4917
US

IV. Provider business mailing address

1601 KIRKWOOD HWY VA WILMINGTON HOSPITAL
WILMINGTON DE
19805-4917
US

V. Phone/Fax

Practice location:
  • Phone: 302-633-5382
  • Fax: 302-633-5589
Mailing address:
  • Phone: 302-633-5382
  • Fax: 302-633-5589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD073821L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: