Provider Demographics
NPI:1366647075
Name:GHAYTH HAMMAD, MD PSC
Entity Type:Organization
Organization Name:GHAYTH HAMMAD, MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GHAYTH
Authorized Official - Middle Name:MAHMOUD
Authorized Official - Last Name:HAMMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-526-9562
Mailing Address - Street 1:234 W PORTER ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42261-8629
Mailing Address - Country:US
Mailing Address - Phone:270-526-9652
Mailing Address - Fax:270-526-9655
Practice Address - Street 1:234 PORTER ST
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:KY
Practice Address - Zip Code:42261-8629
Practice Address - Country:US
Practice Address - Phone:270-526-9652
Practice Address - Fax:270-526-9655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35218174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64994130Medicaid
KY00316Medicare PIN
KYH05439Medicare UPIN