1083278477 NPI number — MR. MOHAMED MAALI GUMAA MOHAMED M.D.

Table of content: MR. MOHAMED MAALI GUMAA MOHAMED M.D. (NPI 1083278477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083278477 NPI number — MR. MOHAMED MAALI GUMAA MOHAMED M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOHAMED
Provider First Name:
MOHAMED MAALI
Provider Middle Name:
GUMAA
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083278477
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
12/23/2019
NPI Reactivation Date:
02/03/2020

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 7, TRUE BLUE, SCHOOL OF MEDICINE, ST GEORGE'S
Provider Second Line Business Mailing Address:
5TH FLOOR, MORRIS ALPERT BUILDING, PHARMACOLOGY DEPARTM
Provider Business Mailing Address City Name:
ST. GEORGE'S
Provider Business Mailing Address State Name:
ST. GEORGE'S
Provider Business Mailing Address Postal Code:
00000
Provider Business Mailing Address Country Code:
GD
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6420 CLAYTON ROAD SSM ST. MARY'S HOSPITAL
Provider Second Line Business Practice Location Address:
DEPARTMENT OF INTERNAL MEDICINE
Provider Business Practice Location Address City Name:
ST. LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-768-8778
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/01/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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