Healthcare Provider Details

I. General information

NPI: 1326032525
Provider Name (Legal Business Name): HISHAM M HAFEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 04/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 TEMPLE STREET SUITE 105
NASHUA NH
03060
US

IV. Provider business mailing address

30 TEMPLE STREET SUITE 105
NASHUA NH
03060
US

V. Phone/Fax

Practice location:
  • Phone: 603-880-9880
  • Fax: 603-402-9727
Mailing address:
  • Phone: 603-880-9880
  • Fax: 603-402-9727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number7461
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number41531
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number7461
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number41531
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: