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General NPI Number Information
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NPI Number | 1295141455
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Entity Type | Individual
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Provider Name | KOMAL MASOOD M.D
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Gender | Female
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Dates
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Enumeration Date | 07/09/2014
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | 502 VAN BUREN ST
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City | FOSTORIA
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State | OH
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Zip | 44830-1533
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Country | US
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Telephone | 419-334-3869
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Fax |
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Provider Business Mailing Address
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Address Line | 2221 HAYES AVE
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City | FREMONT
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State | OH
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Zip | 43420-2632
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Country | US
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Telephone | 419-334-8943
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301105319
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License Number State | MI
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