Provider Demographics
NPI:1265600795
Name:MADY, EHAB NABIL HANNA (DO)
Entity type:Individual
Prefix:DR
First Name:EHAB
Middle Name:NABIL HANNA
Last Name:MADY
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 SUPERIOR AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-2778
Mailing Address - Country:US
Mailing Address - Phone:949-631-6002
Mailing Address - Fax:949-631-6982
Practice Address - Street 1:320 SUPERIOR AVE STE 250
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-2778
Practice Address - Country:US
Practice Address - Phone:949-631-6002
Practice Address - Fax:949-631-6982
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10166207R00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01398004OtherMEDICARE RAILROAD
CAP01398004OtherMEDICARE RAILROAD
CABC847XMedicare PIN