Provider Demographics
NPI:1912993031
Name:MAKHZOUMI, HASSAN M
Entity type:Individual
Prefix:DR
First Name:HASSAN
Middle Name:M
Last Name:MAKHZOUMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SISTER PIERRE DR
Mailing Address - Street 2:STE 505
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7516
Mailing Address - Country:US
Mailing Address - Phone:410-494-8668
Mailing Address - Fax:410-825-6343
Practice Address - Street 1:120 SISTER PIERRE DR
Practice Address - Street 2:STE 505
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7516
Practice Address - Country:US
Practice Address - Phone:410-494-8668
Practice Address - Fax:410-825-6343
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0022530207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
604335194801OtherBLUE SHIELD
H0014731OtherRR MEDICARE
T330OtherFEDERAL
2122354OtherMAMSI
B70942Medicare UPIN
604335194801OtherBLUE SHIELD