Provider Demographics
NPI:1891766408
Name:HANNA, AMAL (MD)
Entity Type:Individual
Prefix:DR
First Name:AMAL
Middle Name:
Last Name:HANNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMAL
Other - Middle Name:E
Other - Last Name:HANNA-AWAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3170 N FEDERAL HWY
Mailing Address - Street 2:SUITE 212
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-6700
Mailing Address - Country:US
Mailing Address - Phone:954-943-0088
Mailing Address - Fax:954-943-0082
Practice Address - Street 1:3170 N FEDERAL HWY
Practice Address - Street 2:SUITE 212
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-6700
Practice Address - Country:US
Practice Address - Phone:954-943-0088
Practice Address - Fax:954-943-0082
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77207207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH09609Medicare UPIN
FL81017Medicare ID - Type Unspecified