Healthcare Provider Details

I. General information

NPI: 1497765598
Provider Name (Legal Business Name): HATEM MAHMOUD HOSSINO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 MORRIS ST STE 101
CHARLESTON WV
25301-1842
US

IV. Provider business mailing address

415 MORRIS ST STE 101
CHARLESTON WV
25301-1842
US

V. Phone/Fax

Practice location:
  • Phone: 304-343-8181
  • Fax: 304-343-8247
Mailing address:
  • Phone: 304-343-8181
  • Fax: 304-343-8247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number10690
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number10690
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: