1518311448 NPI number — FATIMA A MOHIUDDIN M.D.

Table of content: FATIMA A MOHIUDDIN M.D. (NPI 1518311448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518311448 NPI number — FATIMA A MOHIUDDIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOHIUDDIN
Provider First Name:
FATIMA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1518311448
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 640
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLYWOOD
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20636-0640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-373-7900
Provider Business Mailing Address Fax Number:
301-373-6900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6196 OXON HILL RD STE 520
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXON HILL
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20745-3112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-373-7900
Provider Business Practice Location Address Fax Number:
301-373-6900
Provider Enumeration Date:
04/18/2016

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: "N" .
  • Taxonomy code: 207R00000X , with the licence number: D0084634 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 391081400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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