Provider Demographics
NPI:1376545129
Name:HAMAD, ADIBA (MD)
Entity Type:Individual
Prefix:
First Name:ADIBA
Middle Name:
Last Name:HAMAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2142 N COVE BLVD
Mailing Address - Street 2:5-SOUTH PEDIATRICS
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3895
Mailing Address - Country:US
Mailing Address - Phone:419-291-8993
Mailing Address - Fax:419-479-6102
Practice Address - Street 1:2142 N COVE BLVD
Practice Address - Street 2:5-SOUTH PEDIATRICS
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3895
Practice Address - Country:US
Practice Address - Phone:419-291-8993
Practice Address - Fax:419-479-6102
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074991208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
14228OtherHPM
MI4729927Medicaid
MI5202170Medicaid
OH2129422Medicaid
OH05227OtherPHC
OH000000358019OtherANTHEM
7745371OtherAETNA
000000520830OtherANTHEM
OH352827699-006OtherMMO
352827699-007OtherMMO
OH2129422Medicaid
OHHA4091363Medicare PIN
OH05227OtherPHC