Healthcare Provider Details

I. General information

NPI: 1063484582
Provider Name (Legal Business Name): MAHMOUD I HAMZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 CHURCH ST
LAKE PLACID NY
12946-1805
US

IV. Provider business mailing address

84 N OHIOVILLE RD
NEW PALTZ NY
12561-3400
US

V. Phone/Fax

Practice location:
  • Phone: 518-523-3311
  • Fax:
Mailing address:
  • Phone: 845-853-5909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101269291
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number237858-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number26454
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: