Healthcare Provider Details

I. General information

NPI: 1639674658
Provider Name (Legal Business Name): SHERIF MAGDY MOAWAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 PARK CENTER CT.
TOLEDO OH
43615
US

IV. Provider business mailing address

5757 PARK CENTER CT.
TOLEDO OH
43615
US

V. Phone/Fax

Practice location:
  • Phone: 419-474-4064
  • Fax: 419-472-2772
Mailing address:
  • Phone: 419-474-4064
  • Fax: 419-472-2772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35.150574
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301511596
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberD0097749
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD475693
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: