Healthcare Provider Details

I. General information

NPI: 1336702406
Provider Name (Legal Business Name): MOHAMMED MUTTAHHAR MOHIUDDIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11116 MEDICAL CAMPUS RD
HAGERSTOWN MD
21742-6710
US

IV. Provider business mailing address

11116 MEDICAL CAMPUS RD
HAGERSTOWN MD
21742-6710
US

V. Phone/Fax

Practice location:
  • Phone: 301-790-8380
  • Fax:
Mailing address:
  • Phone: 301-790-8380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD486756
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberD0104273
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: