Healthcare Provider Details

I. General information

NPI: 1538257076
Provider Name (Legal Business Name): AHMED EL GAMMAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 MEMORIAL DRIVE SUITE 2
MANCHESTER KY
40962-6195
US

IV. Provider business mailing address

3200 MACCORKLE AVE SE STE B16
CHARLESTON WV
25304-1227
US

V. Phone/Fax

Practice location:
  • Phone: 606-598-8813
  • Fax: 606-598-0983
Mailing address:
  • Phone: 606-598-5104
  • Fax: 606-598-0983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number26248
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number26248
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: