Healthcare Provider Details

I. General information

NPI: 1528502317
Provider Name (Legal Business Name): HAMADA MAHMOUD MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2016
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 US ROUTE 60 EAST SUITE 175
HUNTINGTON WV
25705-2058
US

IV. Provider business mailing address

5505 US ROUTE 60 EAST SUITE 175
HUNTINGTON WV
25705-2058
US

V. Phone/Fax

Practice location:
  • Phone: 304-948-6754
  • Fax: 304-948-6752
Mailing address:
  • Phone: 304-948-6754
  • Fax: 304-948-6752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number20022
License Number StateWV

VIII. Authorized Official

Name: SARAH VANCE
Title or Position: BILLING MANAGER
Credential:
Phone: 304-731-5823