Provider Demographics
NPI:1205097110
Name:EL MASRY, HICHAM (MD)
Entity type:Individual
Prefix:
First Name:HICHAM
Middle Name:
Last Name:EL MASRY
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 1:6402 E SUPERSTITION SPRINGS BLVD STE 224
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4394
Mailing Address - Country:US
Mailing Address - Phone:480-865-6100
Mailing Address - Fax:480-461-4261
Practice Address - Street 1:13400 E SHEA BLVD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-5452
Practice Address - Country:US
Practice Address - Phone:480-301-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01068703A207RC0000X, 207RC0001X
AZ51687207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000694490OtherANTHEM BCBS
INP00945280OtherRAILROAD MEDICARE (SVMG)
AZ106658Medicaid
IN201007910Medicaid
IN201007910Medicaid
INP00945280OtherRAILROAD MEDICARE (SVMG)
AZZ186995Medicare PIN