Healthcare Provider Details

I. General information

NPI: 1366895500
Provider Name (Legal Business Name): EJAZ MAHMOOD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 TOWNSHIP LINE RD STE G1
ELKINS PARK PA
19027-2273
US

IV. Provider business mailing address

50 TOWNSHIP LINE RD STE G1
ELKINS PARK PA
19027-2273
US

V. Phone/Fax

Practice location:
  • Phone: 215-572-5200
  • Fax:
Mailing address:
  • Phone: 215-572-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT211494
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD492038
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberC1-0024078
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: