Provider Demographics
NPI:1578514501
Name:MIKHAIL, HOSNY (MD)
Entity Type:Individual
Prefix:DR
First Name:HOSNY
Middle Name:
Last Name:MIKHAIL
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 1:1020 THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY SHORE
Mailing Address - State:PA
Mailing Address - Zip Code:17740-1729
Mailing Address - Country:US
Mailing Address - Phone:570-398-5122
Mailing Address - Fax:814-432-4986
Practice Address - Street 1:1020 THOMPSON ST
Practice Address - Street 2:
Practice Address - City:JERSEY SHORE
Practice Address - State:PA
Practice Address - Zip Code:17740-1729
Practice Address - Country:US
Practice Address - Phone:570-398-5122
Practice Address - Fax:814-432-4986
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039483L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001108260Medicaid
PA001108260Medicaid
PA023173Medicare ID - Type Unspecified