Healthcare Provider Details

I. General information

NPI: 1548297500
Provider Name (Legal Business Name): HOSSAM KHAMIS HAMDA M.B.CH.B
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LOTHROP ST # E204
PITTSBURGH PA
15213-2536
US

IV. Provider business mailing address

200 LOTHROP ST DEPT OF
PITTSBURGH PA
15213-2536
US

V. Phone/Fax

Practice location:
  • Phone: 412-647-0104
  • Fax: 414-259-9290
Mailing address:
  • Phone: 740-504-9671
  • Fax: 414-259-9290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number47313- 020
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberMD459507
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: