Provider Demographics
NPI:1194605451
Name:ISMAIL, HATEM
Entity type:Individual
Prefix:
First Name:HATEM
Middle Name:
Last Name:ISMAIL
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 1:112 MILLER BRAGG CIRCLE 12C
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOPE
Mailing Address - State:WV
Mailing Address - Zip Code:25880
Mailing Address - Country:US
Mailing Address - Phone:540-514-2419
Mailing Address - Fax:540-514-2419
Practice Address - Street 1:112 MILLER BRAGG CIRCLE 12C
Practice Address - Street 2:
Practice Address - City:MOUNT HOPE
Practice Address - State:WV
Practice Address - Zip Code:25880
Practice Address - Country:US
Practice Address - Phone:540-514-2419
Practice Address - Fax:540-514-2419
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)