Provider Demographics
NPI:1225080443
Name:MAHMOUD, HATIM AHMED (MD)
Entity Type:Individual
Prefix:DR
First Name:HATIM
Middle Name:AHMED
Last Name:MAHMOUD
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:PO BOX 16414
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-6414
Mailing Address - Country:US
Mailing Address - Phone:866-497-8332
Mailing Address - Fax:919-967-6647
Practice Address - Street 1:201 S MAIN ST
Practice Address - Street 2:SUITE 3400
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-2927
Practice Address - Country:US
Practice Address - Phone:434-791-4070
Practice Address - Fax:434-791-4072
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234987207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA289591OtherBC/BS (ANTHEM)
NC890668GMedicaid
H93461Medicare UPIN
VA00V588P20Medicare ID - Type Unspecified