Healthcare Provider Details

I. General information

NPI: 1629174966
Provider Name (Legal Business Name): MOHAMAD ALABRASH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5430 CAMPBELL BLVD STE 213
WHITE MARSH MD
21162-5504
US

IV. Provider business mailing address

PO BOX 44090
NOTTINGHAM MD
21236-6090
US

V. Phone/Fax

Practice location:
  • Phone: 443-678-1290
  • Fax: 443-678-1292
Mailing address:
  • Phone: 443-678-1290
  • Fax: 443-678-1292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberD0037612
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier5487919
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: