Healthcare Provider Details

I. General information

NPI: 1972927325
Provider Name (Legal Business Name): HISHAM HAMDAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2014
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PLZ
DAYTON OH
45404-1873
US

IV. Provider business mailing address

1 CHILDRENS PLZ
DAYTON OH
45404-1873
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.134950
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number35.134950
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: