Provider Demographics
NPI:1104812080
Name:HAMADY, GHASSAN T (MD)
Entity type:Individual
Prefix:
First Name:GHASSAN
Middle Name:T
Last Name:HAMADY
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:7150 W 20TH AVE
Practice Address - Street 2:SUITE 406
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016
Practice Address - Country:US
Practice Address - Phone:305-820-1050
Practice Address - Fax:305-820-1559
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0041672208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042153700Medicaid
FL4072660OtherAETNA
FLP01601036OtherRR MEDICARE
FL026562OtherNHP
FLP511048OtherOPTIMUM
FL0075154OtherGHI
FL4467OtherDIMENSIONS
FL58462OtherBCBS
FL22846OtherWELLCARE
FLP01619OtherFREEDOM
FL013123OtherAVMED
FL22846OtherSTAYWELL
FL2348185OtherCIGNA
FL22846OtherSTAYWELL
FLP511048OtherOPTIMUM