Healthcare Provider Details

I. General information

NPI: 1962744268
Provider Name (Legal Business Name): MOHAMAD HANOUNEH M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 LOCH RAVEN BLVD STE 3N
BALTIMORE MD
21239
US

IV. Provider business mailing address

5601 LOCH RAVEN BLVD STE 3N
BALTIMORE MD
21239-2945
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-2200
  • Fax:
Mailing address:
  • Phone: 443-444-3775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberD84312
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: