Healthcare Provider Details

I. General information

NPI: 1639279342
Provider Name (Legal Business Name): MAMDOUH RIAD MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 INDEPENDENCE DR STE 3
HYANNIS MA
02601-1898
US

IV. Provider business mailing address

100 INDEPENDENCE DR STE 3
HYANNIS MA
02601-1898
US

V. Phone/Fax

Practice location:
  • Phone: 508-790-4568
  • Fax: 508-790-1800
Mailing address:
  • Phone: 508-790-4568
  • Fax: 508-790-1800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number76855
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY GOLDSMITH
Title or Position: COO
Credential:
Phone: 402-202-5823