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General NPI Number Information
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NPI Number | 1912952540
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Entity Type | Individual
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Provider Name | MAHMOUD ABU GHANAM MD
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Gender | Male
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 1987 STATE ROUTE 52 STE 10
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City | LIBERTY
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State | NY
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Zip | 12754-8317
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Country | US
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Telephone | 845-292-0078
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Fax | 845-292-3244
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Provider Business Mailing Address
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Address Line | PO BOX 190
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City | FERNDALE
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State | NY
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Zip | 12734-0558
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Country | US
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Telephone | 845-292-0078
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Fax | 845-292-3244
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 272625
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 272625
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License Number State | NY
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