Healthcare Provider Details

I. General information

NPI: 1962217802
Provider Name (Legal Business Name): THAMER H MOQDADY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 HOPLEY AVE
BUCYRUS OH
44820-2708
US

IV. Provider business mailing address

9062 HOLQUEST DR
LEWIS CENTER OH
43035-8427
US

V. Phone/Fax

Practice location:
  • Phone: 614-674-1609
  • Fax:
Mailing address:
  • Phone: 614-614-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: