Healthcare Provider Details

I. General information

NPI: 1154390953
Provider Name (Legal Business Name): MOUHAMAD O. ANNOUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 YORK RD STE 240
TOWSON MD
21204
US

IV. Provider business mailing address

7801 YORK RD STE 240
TOWSON MD
21204-7446
US

V. Phone/Fax

Practice location:
  • Phone: 410-323-9214
  • Fax: 410-323-9215
Mailing address:
  • Phone: 410-323-9214
  • Fax: 410-323-9215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD0023427
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberD0023427
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: