1023293826 NPI number — MOHAMMED M MOHIUDDIN MD

Table of content: MOHAMMED M MOHIUDDIN MD (NPI 1023293826)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023293826 NPI number — MOHAMMED M MOHIUDDIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOHIUDDIN
Provider First Name:
MOHAMMED
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1023293826
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/31/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 TOLL HOUSE
Provider Second Line Business Mailing Address:
BUILDING B2
Provider Business Mailing Address City Name:
FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-694-8080
Provider Business Mailing Address Fax Number:
301-694-8089

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 TOLL HOUSE AVE
Provider Second Line Business Practice Location Address:
BLDG B2
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-694-8080
Provider Business Practice Location Address Fax Number:
301-694-8089
Provider Enumeration Date:
12/31/2007

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: 208800000X , with the licence number:  D0020015 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208800000X , with the licence number: 10996 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3003208000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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