MEDICARE: MAHMOOD ABOSARA

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1548610090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAHMOOD ABOSARA

Provider Business Mailing Address
First Line	:	4333 MANCHESTER AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-2137
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4333 MANCHESTER AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-2137
Country	:	US
Telephone Number	:	314-665-9672
Fax Number	:

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

Provider Enumeration Date	:	06/15/2016
Last Update Date	:	06/15/2016

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Directions to “ MAHMOOD ABOSARA ” Practice Location

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