Provider Demographics
NPI:1689087306
Name:ABUSAMHADANA, HISHAM (MD)
Entity Type:Individual
Prefix:
First Name:HISHAM
Middle Name:
Last Name:ABUSAMHADANA
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 1:232 W 25TH ST FL 9
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16544-2722
Mailing Address - Country:US
Mailing Address - Phone:814-452-7605
Mailing Address - Fax:814-452-5039
Practice Address - Street 1:2314 SASSAFRAS ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2722
Practice Address - Country:US
Practice Address - Phone:814-452-5105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT207267207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine