Healthcare Provider Details

I. General information

NPI: 1215771563
Provider Name (Legal Business Name): CARLO MOHAMED CSA, CSFA, MSA, LSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 BATTLEFIELD BLVD N
CHESAPEAKE VA
23320-4941
US

IV. Provider business mailing address

321 DUKE ST APT 112
NORFOLK VA
23510-1267
US

V. Phone/Fax

Practice location:
  • Phone: 757-312-8121
  • Fax:
Mailing address:
  • Phone: 703-717-8949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number0136000942
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: