MEDICARE: DR. MOHAMED G MOHAMED 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	207Q00000X	Family Medicine Physician	MD430130	PA
2	207QG0300X	Geriatric Medicine (Family Medicine) Physician	ME116369	FL
3	207QG0300X	Geriatric Medicine (Family Medicine) Physician	252170	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	ME116369	OTHER	FL	MEDICAL LICENSE

General Provider Information

NPI Number	:	1386721579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMED G MOHAMED MD

Provider Business Mailing Address
First Line	:	6101 BLUE LAGOON DR STE 200
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3168
Country	:	US
Telephone Number	:	305-500-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1914 STATE ROAD 44
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-8345
Country	:	US
Telephone Number	:	386-428-3241
Fax Number	:	844-295-1379

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	01/16/2025

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