Healthcare Provider Details

I. General information

NPI: 1215619143
Provider Name (Legal Business Name): MOHAMMED SHAHADAT HOSSAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 08/01/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N JAMES ST
ROME NY
13440-3524
US

IV. Provider business mailing address

8915 PARSONS BLVD APT 5F
JAMAICA NY
11432-6056
US

V. Phone/Fax

Practice location:
  • Phone: 315-533-1600
  • Fax:
Mailing address:
  • Phone: 347-285-5909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP123101
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: