Healthcare Provider Details

I. General information

NPI: 1912844531
Provider Name (Legal Business Name): MAHMOUD ABDELSALAM MOHAMED ABDELSALAM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 SW 16TH ST STE 1210
GAINESVILLE FL
32608-1128
US

IV. Provider business mailing address

1329 SW 16TH ST STE 1210
GAINESVILLE FL
32608-1128
US

V. Phone/Fax

Practice location:
  • Phone: 506-378-1345
  • Fax: 506-378-1345
Mailing address:
  • Phone: 506-378-1345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number1986
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: