Healthcare Provider Details

I. General information

NPI: 1689625113
Provider Name (Legal Business Name): TALAL HAMDAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 N MACDILL AVE
TAMPA FL
33607-2205
US

IV. Provider business mailing address

PO BOX 4706
TAMPA FL
33677-4706
US

V. Phone/Fax

Practice location:
  • Phone: 813-280-0202
  • Fax: 813-280-0203
Mailing address:
  • Phone: 813-280-0202
  • Fax: 813-280-0203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01062167A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME113924
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberME113924
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberME113924
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME113924
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: