Provider Demographics
NPI:1568556512
Name:HAMMOD, RIYADH S (MD)
Entity Type:Individual
Prefix:
First Name:RIYADH
Middle Name:S
Last Name:HAMMOD
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:PO BOX 183
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-0137
Mailing Address - Country:US
Mailing Address - Phone:856-451-9395
Mailing Address - Fax:856-451-8615
Practice Address - Street 1:1103 W SHERMAN AVE
Practice Address - Street 2:BLDG 2 UNIT A
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6915
Practice Address - Country:US
Practice Address - Phone:856-692-9900
Practice Address - Fax:856-692-9911
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA067470207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ875240101Medicaid
NJ053227Medicare PIN
NJ875240101Medicaid