Healthcare Provider Details

I. General information

NPI: 1568087237
Provider Name (Legal Business Name): AHMED MOHAMED HAGGAG M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date: 02/10/2022
Reactivation Date: 03/13/2023

III. Provider practice location address

807 CHILDRENS WAY
JACKSONVILLE FL
32207-8426
US

IV. Provider business mailing address

100 WOODS RD
VALHALLA NY
10595-1530
US

V. Phone/Fax

Practice location:
  • Phone: 904-697-3600
  • Fax:
Mailing address:
  • Phone: 914-493-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberME179788
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: