Provider Demographics
NPI:1194834754
Name:MAHGOUB, SIHAM M (MD)
Entity type:Individual
Prefix:DR
First Name:SIHAM
Middle Name:M
Last Name:MAHGOUB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SENTARA CIR STE 201B
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-5716
Mailing Address - Country:US
Mailing Address - Phone:757-345-4655
Mailing Address - Fax:757-390-4892
Practice Address - Street 1:400 SENTARA CIR STE 201B
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5716
Practice Address - Country:US
Practice Address - Phone:757-345-4655
Practice Address - Fax:757-390-4892
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2025-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239997207RI0200X, 207R00000X
NY2189841207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02224422Medicaid
NY020AH1Medicare ID - Type Unspecified
NY02224422Medicaid