Provider Demographics
NPI:1932763802
Name:FARGALY, HITHEM AHMED ATIA (MD)
Entity Type:Individual
Prefix:DR
First Name:HITHEM
Middle Name:AHMED ATIA
Last Name:FARGALY
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 1:8756 TOWN AND COUNTRY BLVD APT F
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3048
Mailing Address - Country:US
Mailing Address - Phone:302-670-2161
Mailing Address - Fax:
Practice Address - Street 1:4201 ST.ANTOINE
Practice Address - Street 2:UHC 9C
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-5147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-26
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WY16388A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program