Healthcare Provider Details

I. General information

NPI: 1093029134
Provider Name (Legal Business Name): DR. MAHMOUD ZAHRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2010
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222-224 EAST MAIN STREET
SPRINGVILLE NY
14141-1443
US

IV. Provider business mailing address

2900 MAIN ST APT 100
BRIDGEPORT CT
06606-4213
US

V. Phone/Fax

Practice location:
  • Phone: 716-592-2871
  • Fax:
Mailing address:
  • Phone: 203-361-8361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number286743
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberTRN 14634
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: