Healthcare Provider Details

I. General information

NPI: 1801738612
Provider Name (Legal Business Name): ESLAM MAHMOUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11352 MOULTRIE AVE
BATON ROUGE LA
70817-7859
US

IV. Provider business mailing address

11352 MOULTRIE AVE
BATON ROUGE LA
70817-7859
US

V. Phone/Fax

Practice location:
  • Phone: 225-288-9993
  • Fax:
Mailing address:
  • Phone: 225-288-9993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number218547
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: