Healthcare Provider Details

I. General information

NPI: 1467045757
Provider Name (Legal Business Name): MOHAMED ALHEDAI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 CRAIN HWY S STE 6
GLEN BURNIE MD
21061-3661
US

IV. Provider business mailing address

6936 ANDERSONS WAY APT 104
LAUREL MD
20707-6951
US

V. Phone/Fax

Practice location:
  • Phone: 410-670-9048
  • Fax:
Mailing address:
  • Phone: 202-699-1062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number26548
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: