Provider Demographics
NPI:1063484582
Name:HAMZA, MAHMOUD I (MD)
Entity Type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:I
Last Name:HAMZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 N OHIOVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-3400
Mailing Address - Country:US
Mailing Address - Phone:845-853-5909
Mailing Address - Fax:
Practice Address - Street 1:29 CHURCH ST
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:NY
Practice Address - Zip Code:12946-1805
Practice Address - Country:US
Practice Address - Phone:518-523-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101269291207P00000X
NY237858-1207R00000X
WV26454207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY336AN33441Medicare ID - Type Unspecified
NY146732Medicare UPIN