Provider Demographics
NPI:1710169990
Name:KAOUD, HANY AZIZ (MD)
Entity Type:Individual
Prefix:
First Name:HANY
Middle Name:AZIZ
Last Name:KAOUD
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 1:4300 SAPPHIRE CT 110
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-9079
Mailing Address - Country:US
Mailing Address - Phone:252-830-7561
Mailing Address - Fax:252-413-0932
Practice Address - Street 1:154 BEACON DRIVE
Practice Address - Street 2:SUITE I
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-7860
Practice Address - Country:US
Practice Address - Phone:252-353-1114
Practice Address - Fax:252-353-1119
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009016802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5914592Medicaid
NC5914592Medicaid