Provider Demographics
NPI:1356321442
Name:HAMZE, JAY MOHAMAD (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:MOHAMAD
Last Name:HAMZE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JIHAD
Other - Middle Name:MOHAMAD
Other - Last Name:HAMZE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1735 27TH ST STE B06
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2681
Mailing Address - Country:US
Mailing Address - Phone:740-356-8681
Mailing Address - Fax:740-353-7900
Practice Address - Street 1:1711 27TH ST STE 206
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2669
Practice Address - Country:US
Practice Address - Phone:740-356-8772
Practice Address - Fax:740-356-1264
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.129664207RC0000X, 207UN0901X, 207RI0011X
MI4301079292207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4757108Medicaid
OH0187578Medicaid
06167704OtherECFMG
5315021347OtherCONTROLLED SUBSTANCE
I 30363Medicare UPIN
06167704OtherECFMG