Provider Demographics
NPI:1407831845
Name:HAMDANI, MOHAMED P (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:P
Last Name:HAMDANI
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 1:401 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-3404
Mailing Address - Country:US
Mailing Address - Phone:413-737-8328
Mailing Address - Fax:413-737-1377
Practice Address - Street 1:401 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3404
Practice Address - Country:US
Practice Address - Phone:413-737-8328
Practice Address - Fax:413-737-1377
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA45400208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
J06308OtherBS MA
A59058Medicare UPIN
J06308OtherBS MA