Healthcare Provider Details

I. General information

NPI: 1346828522
Provider Name (Legal Business Name): MOHAMMAD TAMER HANAFY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 FRANKFORD AVE # 10
PHILADELPHIA PA
19124-3602
US

IV. Provider business mailing address

2621 S JEFFERSON AVE APT 324
SPRINGFIELD MO
65807-3778
US

V. Phone/Fax

Practice location:
  • Phone: 888-296-4742
  • Fax:
Mailing address:
  • Phone: 765-760-4038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD491508
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2025009753
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: