MEDICARE: SAEEDA A MAHMUD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	189663	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	A400063517	OTHER	NY	PTAN

General Provider Information

NPI Number	:	1205935087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAEEDA A MAHMUD MD

Provider Business Mailing Address
First Line	:	10 HEALTHY WAY
Second Line	:
City	:	ELLENVILLE
State	:	NY
Zip	:	12428-5612
Country	:	US
Telephone Number	:	845-647-2510
Fax Number	:	845-647-2975

Provider Business Practice Location Address
First Line	:	10 HEALTHY WAY
Second Line	:
City	:	ELLENVILLE
State	:	NY
Zip	:	12428-5612
Country	:	US
Telephone Number	:	845-647-2510
Fax Number	:	845-647-2975

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	10/23/2012

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