=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730460049
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALEXANDRIA MEDICAL ASSOCIATION PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2011
-----------------------------------------------------
Last Update Date | 09/11/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1836 SNAKE RIVER RD STE C
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77449-7753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-578-9000
-----------------------------------------------------
Fax | 281-578-9004
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1836 SNAKE RIVER RD STE C
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77449-7753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-578-9000
-----------------------------------------------------
Fax | 281-578-9004
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. MOHAMED MAHDY ABDELMOULA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 832-205-2080
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | P0328
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------