Provider Demographics
NPI:1326032525
Name:HAFEZ, HISHAM M (MD)
Entity Type:Individual
Prefix:
First Name:HISHAM
Middle Name:M
Last Name:HAFEZ
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 1:30 TEMPLE STREET
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060
Mailing Address - Country:US
Mailing Address - Phone:603-880-9880
Mailing Address - Fax:603-402-9727
Practice Address - Street 1:30 TEMPLE STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060
Practice Address - Country:US
Practice Address - Phone:603-880-9880
Practice Address - Fax:603-402-9727
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH74612084P0800X, 2084P0805X
MA415312084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3091074Medicaid
NH30003015Medicaid
NH30003015Medicaid
NHRE1125Medicare PIN