Healthcare Provider Details

I. General information

NPI: 1659069441
Provider Name (Legal Business Name): JOHN ZAKI MOUNIR HANNA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2023
Last Update Date: 08/17/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 MACCORKLE AVE. SE CAMC MEMORIAL HOSPITAL,
CHARLESTON WV
25304
US

IV. Provider business mailing address

1041 TRUMAN AVENUE
OAKVILLE ONTARIO
L6H 1Y7
CA

V. Phone/Fax

Practice location:
  • Phone: 304-388-5590
  • Fax: 304-388-8238
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: