Provider Demographics
NPI:1790264711
Name:HAMMOUD, RENEE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:
Last Name:HAMMOUD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 OLD LANCASTER RD STE 320
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3235
Mailing Address - Country:US
Mailing Address - Phone:610-527-3800
Mailing Address - Fax:
Practice Address - Street 1:825 OLD LANCASTER RD STE 400
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3236
Practice Address - Country:US
Practice Address - Phone:610-525-1202
Practice Address - Fax:610-527-0643
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059980363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant