MEDICARE: TALAL MAHMOOD 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	207RN0300X	Nephrology Physician	4317-320	WI
2	207RN0300X	Nephrology Physician	75793	TN
3	207RN0300X	Nephrology Physician	73588	AZ
4	207RN0300X	Nephrology Physician	MD70019277	WA
5	207RN0300X	Nephrology Physician	76681	MN
6	207RN0300X	Nephrology Physician	EMC0008155	MI
7	207RN0300X	Nephrology Physician	25MA11545200	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036117302	OTHER	IL	LICENSE
2	25MA11545200	OTHER	NJ	LICENSE
3	22075	OTHER	MS	LICENSE

General Provider Information

NPI Number	:	1306041918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TALAL MAHMOOD M.D.

Provider Business Mailing Address
First Line	:	870 PALISADE AVE STE 202
Second Line	:
City	:	TEANECK
State	:	NJ
Zip	:	07666-3445
Country	:	US
Telephone Number	:	551-996-9189
Fax Number	:	201-836-8042

Provider Business Practice Location Address
First Line	:	870 PALISADE AVE STE 202
Second Line	:
City	:	TEANECK
State	:	NJ
Zip	:	07666-3445
Country	:	US
Telephone Number	:	551-996-9189
Fax Number	:	201-836-8042

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

Provider Enumeration Date	:	06/15/2007
Last Update Date	:	03/03/2026

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Directions to “ TALAL MAHMOOD M.D.” Practice Location

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