Provider Demographics
NPI:1689625113
Name:HAMDAN, TALAL (MD)
Entity Type:Individual
Prefix:
First Name:TALAL
Middle Name:
Last Name:HAMDAN
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 4706
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33677-4706
Mailing Address - Country:US
Mailing Address - Phone:813-280-0202
Mailing Address - Fax:813-280-0203
Practice Address - Street 1:17 DAVIS BLVD
Practice Address - Street 2:SUITE 313
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3475
Practice Address - Country:US
Practice Address - Phone:813-280-0202
Practice Address - Fax:813-280-0203
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062167A207RC0000X
FLME113924207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008260200Medicaid
IN200828040Medicaid
FL008260200Medicaid
FLGV187YMedicare PIN
INM400061632Medicare PIN
INH53448Medicare UPIN