Healthcare Provider Details

I. General information

NPI: 1881033140
Provider Name (Legal Business Name): NADIM MAHMUD MD, MS, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE STREET 3 DULLES BUILDING
PHILADELPHIA PA
19104-4206
US

IV. Provider business mailing address

3400 SPRUCE STREET 3 DULLES BUILDING
PHILADELPHIA PA
19104-4206
US

V. Phone/Fax

Practice location:
  • Phone: 215-349-8222
  • Fax: 215-349-5915
Mailing address:
  • Phone: 215-349-8222
  • Fax: 215-349-5915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD462454
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License NumberMD462454
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD462454
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: