Healthcare Provider Details

I. General information

NPI: 1720378243
Provider Name (Legal Business Name): ISMAIL HAMAM M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 04/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

473 WEST 12TH AVE DHLRI 200
COLUMBUS OH
43210
US

IV. Provider business mailing address

588 STINCHCOMB DR APT # 1
COLUMBUS OH
43202
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-3943
  • Fax:
Mailing address:
  • Phone: 614-260-7787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number57.018949
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: