Basic Information
| Provider Information | |||||||||
| NPI: | 1811201882 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HIJJAWI | ||||||||
| FirstName: | SHADI | ||||||||
| MiddleName: | BASSAM | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MBBS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2525 COURT DR | ||||||||
| Address2: | GASTON MEMORIAL HOSPITAL, DEPT OF HOSPITAL MEDICINE | ||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280542140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048342000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2525 COURT DR | ||||||||
| Address2: | GASTON MEMORIAL HOSPITAL, DEPT OF HOSPITAL MEDICINE | ||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280542140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048342000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2010 | ||||||||
| LastUpdateDate: | 07/01/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | BP10037490 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.