1033210893 NPI number — DR. SHARAB MOHAMED M.D.

Table of content: DR. SHARAB MOHAMED M.D. (NPI 1033210893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033210893 NPI number — DR. SHARAB MOHAMED M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOHAMED
Provider First Name:
SHARAB
Provider Middle Name:
Provider Name Prefix Text:
DR.
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:
1033210893
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3345 JOG RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENACRES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33467-2010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-965-0813
Provider Business Mailing Address Fax Number:
561-965-7505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3345 JOG RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENACRES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33467-2010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-965-0813
Provider Business Practice Location Address Fax Number:
561-965-7505
Provider Enumeration Date:
09/26/2006

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: 207R00000X , with the licence number:  ME00064608 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0402795 . This is a "UNITED HEALTH CARE ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 33186 . This is a "BCBS GROUP ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 650518562 . This is a "VISTA HEALTH CARE ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 650518562 . This is a "FED ID FOR ALL OTHER COMM" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 241798 . This is a "AVMED INDIVIDUAL ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 650518562 . This is a "GHI INSURANCE ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 964625 . This is a "AETNA HEALTH INSURANCE ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 23558 . This is a "BLUE CROSS BLUE SHIELD ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 262403600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 650518562 . This is a "TOTAL HEALTH CHOICE ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 650518562 . This is a "CHAMPUS ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 375690400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010371900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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