Healthcare Provider Details

I. General information

NPI: 1760503270
Provider Name (Legal Business Name): MAAROUF AHMAD HOTEIT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTER BLVD PERELMAN BLDG - GASTROENTEROLOGY
PHILADELPHIA PA
19104-4306
US

IV. Provider business mailing address

3400 CIVIC CENTER BOULEVARD
PHILADELPHIA PA
19104-4306
US

V. Phone/Fax

Practice location:
  • Phone: 215-349-8222
  • Fax: 215-662-6530
Mailing address:
  • Phone: 215-349-8222
  • Fax: 215-662-6530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA09678300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD433844
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: