Provider Demographics
NPI:1346828522
Name:HANAFY, MOHAMMAD TAMER (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:TAMER
Last Name:HANAFY
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 1:2621 S JEFFERSON AVE APT 324
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-3778
Mailing Address - Country:US
Mailing Address - Phone:765-760-4038
Mailing Address - Fax:
Practice Address - Street 1:4500 FRANKFORD AVE # 10
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-3602
Practice Address - Country:US
Practice Address - Phone:888-296-4742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD491508207R00000X
MO2025009753207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine