Healthcare Provider Details

I. General information

NPI: 1942753389
Provider Name (Legal Business Name): AHMED ABU HANIYEH M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 MILFORD ST STE 605
SALISBURY MD
21804-6938
US

IV. Provider business mailing address

100 E CARROLL ST
SALISBURY MD
21801-5422
US

V. Phone/Fax

Practice location:
  • Phone: 410-334-2227
  • Fax:
Mailing address:
  • Phone: 410-543-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD96303
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD96303
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: