Healthcare Provider Details

I. General information

NPI: 1447445945
Provider Name (Legal Business Name): MOSTAFA BORAHAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MOSTAFA AHMED MD

II. Dates (important events)

Enumeration Date: 09/08/2007
Last Update Date: 04/07/2023
Certification Date: 04/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 EASTERN AVE
BALTIMORE MD
21224-2735
US

IV. Provider business mailing address

4940 EASTERN AVE
BALTIMORE MD
21224-2735
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-0337
  • Fax:
Mailing address:
  • Phone: 410-550-0337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD0081935
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: