1801004627 NPI number — MOHAMMED A. ISLAM M.D.P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801004627 NPI number — MOHAMMED A. ISLAM M.D.P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOHAMMED A. ISLAM M.D.P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1801004627
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4575
Provider Second Line Business Mailing Address:
MOHAMMED AMIRUL ISLAM, MD PA; MSC # 100
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77210-4575
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-963-0000
Provider Business Mailing Address Fax Number:
409-963-1899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3921 N TWIN CITY HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT ARTHUR
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77642-2118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-963-0000
Provider Business Practice Location Address Fax Number:
409-963-1899
Provider Enumeration Date:
05/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ISLAM
Authorized Official First Name:
MOHAMMED
Authorized Official Middle Name:
AMIRUL
Authorized Official Title or Position:
M.D.
Authorized Official Telephone Number:
409-963-0000

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  L4981 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 163755501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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