Healthcare Provider Details

I. General information

NPI: 1730469065
Provider Name (Legal Business Name): BRIGHT FUTURE PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2011
Last Update Date: 08/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

938 S BRADFORD ST
DOVER DE
19904-4140
US

IV. Provider business mailing address

PO BOX 1082
DOVER DE
19903-1082
US

V. Phone/Fax

Practice location:
  • Phone: 856-278-5286
  • Fax:
Mailing address:
  • Phone: 856-278-5286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC10006010
License Number StateDE

VIII. Authorized Official

Name: DR. MAMOON MAHMOUD
Title or Position: CO-OWNER
Credential: M.D.
Phone: 856-278-5286