Healthcare Provider Details

I. General information

NPI: 1164607669
Provider Name (Legal Business Name): AWAIS MASOOD M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8224 242ND STREET
BELLEROSE NY
11426
US

IV. Provider business mailing address

8224 242ND STREET
BELLEROSE NY
11426
US

V. Phone/Fax

Practice location:
  • Phone: 786-853-7813
  • Fax:
Mailing address:
  • Phone: 786-853-7813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME119196
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR0074
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2010-01843
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number71715
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number01077517A
License Number StateIN
# 6
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2010-01843
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: