Healthcare Provider Details

I. General information

NPI: 1891602710
Provider Name (Legal Business Name): MOHAMMED AL NIDAWI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 WATER ST APT B104
SACO ME
04072-2763
US

IV. Provider business mailing address

35 WATER ST APT B104
SACO ME
04072-2763
US

V. Phone/Fax

Practice location:
  • Phone: 207-205-3399
  • Fax:
Mailing address:
  • Phone: 207-205-3399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number4054362
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: