Provider Demographics
NPI:1972574432
Name:MAHMALJY, GHIATH (MD)
Entity Type:Individual
Prefix:DR
First Name:GHIATH
Middle Name:
Last Name:MAHMALJY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14690 SPRING HILL DR
Mailing Address - Street 2:STE 305
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8102
Mailing Address - Country:US
Mailing Address - Phone:352-277-5348
Mailing Address - Fax:352-606-2857
Practice Address - Street 1:11373 CORTEZ BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5414
Practice Address - Country:US
Practice Address - Phone:352-597-8994
Practice Address - Fax:352-597-8901
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME45844207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01194861OtherRR MCR
FL26074OtherBCBS
FLP01194861OtherRR MCR
FLD53447Medicare UPIN
FL40952Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER