MEDICARE: MUHAMMAD A MUMTAZ 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	207R00000X	Internal Medicine Physician	204600	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	35780	OTHER	MA	HEALTHY START
2	J23605	OTHER	MA	BLUE CROSS BLUE SHIELD
3	0025950	OTHER		NEIGHBORHOOD HEALTH PLAN

General Provider Information

NPI Number	:	1902841927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUHAMMAD A MUMTAZ M.D.

Provider Business Mailing Address
First Line	:	BMCHS PROVIDER ENROLLMENT
Second Line	:	960 MASSACHUSETTS AVE FLR 2
City	:	BOS
State	:	MA
Zip	:	02118
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	GSMC - HOSPITALISTS
Second Line	:	235 NORTH PEARL ST
City	:	BROCKTON
State	:	MA
Zip	:	02301-4012
Country	:	US
Telephone Number	:	508-427-3000
Fax Number	:

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

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	03/14/2025

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