Healthcare Provider Details

I. General information

NPI: 1720366552
Provider Name (Legal Business Name): HOSSAIN SAID MAHMOUDIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2011
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6507 DEER POINTE DR
SALISBURY MD
21804-1667
US

IV. Provider business mailing address

6507 DEER POINTE DR
SALISBURY MD
21804-1667
US

V. Phone/Fax

Practice location:
  • Phone: 410-543-9332
  • Fax: 410-543-9237
Mailing address:
  • Phone: 410-543-9332
  • Fax: 410-543-9237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD0080916
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: