Provider Demographics
NPI:1184719874
Name:HAMMAD, GHAYTH MAHMOUD (MD)
Entity type:Individual
Prefix:MR
First Name:GHAYTH
Middle Name:MAHMOUD
Last Name:HAMMAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:234 WEST PORTER ST
Mailing Address - City:MORGANTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42261-0278
Mailing Address - Country:US
Mailing Address - Phone:270-526-9652
Mailing Address - Fax:270-526-9655
Practice Address - Street 1:234 WEST PORTER ST
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:KY
Practice Address - Zip Code:42261-8629
Practice Address - Country:US
Practice Address - Phone:270-526-9652
Practice Address - Fax:270-526-9655
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35218207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64994130Medicaid
KYH05439Medicare UPIN
KY64994130Medicaid