Provider Demographics
NPI:1164590873
Name:HANNA WANG & EZZIDDIN MDS INC
Entity Type:Organization
Organization Name:HANNA WANG & EZZIDDIN MDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABDALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:EZZIDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-461-0038
Mailing Address - Street 1:6690 BETA DR
Mailing Address - Street 2:STE 100
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2361
Mailing Address - Country:US
Mailing Address - Phone:440-461-0038
Mailing Address - Fax:440-461-8820
Practice Address - Street 1:6690 BETA DR
Practice Address - Street 2:STE 100
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-2361
Practice Address - Country:US
Practice Address - Phone:440-461-0038
Practice Address - Fax:440-461-8820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty