Healthcare Provider Details

I. General information

NPI: 1144756214
Provider Name (Legal Business Name): TARICK MEGAHED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2017
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6716 NW 11TH PL STE 200
GAINESVILLE FL
32605-4201
US

IV. Provider business mailing address

5114 PINE ST
BELLAIRE TX
77401-4910
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-9729
  • Fax: 352-331-0137
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME156024
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: