MEDICARE: DR. MARWAN F HAMMOUD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	25MA08440400	NJ
2	207Q00000X	Family Medicine Physician	233296	NY

General Provider Information

NPI Number	:	1851390470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARWAN F HAMMOUD MD

Provider Business Mailing Address
First Line	:	1005 N WASHINGTON AVE
Second Line	:	PO BOX 890
City	:	GREEN BROOK
State	:	NJ
Zip	:	08812-2619
Country	:	US
Telephone Number	:	732-968-8900
Fax Number	:	732-968-4898

Provider Business Practice Location Address
First Line	:	1005 N WASHINGTON AVE
Second Line	:
City	:	GREEN BROOK
State	:	NJ
Zip	:	08812-2619
Country	:	US
Telephone Number	:	732-968-8900
Fax Number	:	732-968-4898

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	01/13/2011

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