Provider Demographics
NPI:1003987678
Name:MAHOOD, TIMOTHY M (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:M
Last Name:MAHOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3219 MERAMEC ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-4305
Mailing Address - Country:US
Mailing Address - Phone:314-351-2716
Mailing Address - Fax:314-351-1286
Practice Address - Street 1:3219 MERAMEC ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-4305
Practice Address - Country:US
Practice Address - Phone:314-351-2716
Practice Address - Fax:314-351-1286
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8D34207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3047884OtherCIGNA
131610OtherBC
04-00464OtherUNITED HEALTH CARE-MCC
33285OtherGHP
43190910401OtherCARE MANAGEMENT RESOURCES
A10272OtherMERCY HEALTH PLAN
0005020417OtherAETNA
131610OtherFEDERAL BCBS
152910OtherHEALTHLINK
MOR8D34OtherLICENSE
MOR8D34OtherLICENSE
33285OtherGHP