Healthcare Provider Details

I. General information

NPI: 1639203847
Provider Name (Legal Business Name): MOHAMAD MAHMOUD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KINGS HWY S STE 1100
ROCHESTER NY
14617-5504
US

IV. Provider business mailing address

222 ALEXANDER ST STE 1100
ROCHESTER NY
14607-4039
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-8585
  • Fax: 585-922-1399
Mailing address:
  • Phone: 585-922-8585
  • Fax: 585-922-8555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036117782
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number269464
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: