MEDICARE: DR. CEAN MAHMUD M.D.

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	208000000X	Pediatrics Physician	305318	NY
2	207Q00000X	Family Medicine Physician	305318	NY
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1285165134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CEAN MAHMUD M.D.

Provider Business Mailing Address
First Line	:	70 N COUNTRY RD STE 105
Second Line	:
City	:	PORT JEFFERSON
State	:	NY
Zip	:	11777-2161
Country	:	US
Telephone Number	:	631-392-8847
Fax Number	:

Provider Business Practice Location Address
First Line	:	31 MAIN RD STE 1
Second Line	:
City	:	RIVERHEAD
State	:	NY
Zip	:	11901-1953
Country	:	US
Telephone Number	:	631-722-4400
Fax Number	:

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

Provider Enumeration Date	:	03/22/2017
Last Update Date	:	04/18/2026

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