MEDICARE: DR. MOHAMED ABDELMEGEED ABDELLA AHMED 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	390200000X	Student in an Organized Health Care Education/Training Program
2	207X00000X	Orthopaedic Surgery Physician	264641	NY
3	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician	264641	NY

General Provider Information

NPI Number	:	1780818609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMED ABDELMEGEED ABDELLA AHMED MD

Provider Business Mailing Address
First Line	:	3060 CRESCENT ST STE B
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11102-3239
Country	:	US
Telephone Number	:	718-502-6161
Fax Number	:

Provider Business Practice Location Address
First Line	:	3060 CRESCENT ST STE B
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11102-3239
Country	:	US
Telephone Number	:	718-502-6161
Fax Number	:

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

Provider Enumeration Date	:	05/06/2009
Last Update Date	:	05/01/2017

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