Healthcare Provider Details

I. General information

NPI: 1083611917
Provider Name (Legal Business Name): MOHAMMAD WALID KAMSHEH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 BYRN ST
CAMBRIDGE MD
21613-1910
US

IV. Provider business mailing address

920 ELKRIDGE LANDING RD
LINTHICUM MD
21090
US

V. Phone/Fax

Practice location:
  • Phone: 410-221-0448
  • Fax: 410-221-1377
Mailing address:
  • Phone: 410-684-2031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD38181
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: