Healthcare Provider Details

I. General information

NPI: 1356307094
Provider Name (Legal Business Name): AYSER C HAMOUDI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 GRANDVIEW AVE
COLUMBUS OH
43212
US

IV. Provider business mailing address

1480 GRANDVIEW AVE
COLUMBUS OH
43212
US

V. Phone/Fax

Practice location:
  • Phone: 614-486-9461
  • Fax: 614-486-2318
Mailing address:
  • Phone: 614-486-9461
  • Fax: 614-486-2318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35034135Q
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: