Provider Demographics
NPI:1023181948
Name:MOHAMMED, NOEL OMAR (MD)
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:OMAR
Last Name:MOHAMMED
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:PO BOX 496
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-0496
Mailing Address - Country:US
Mailing Address - Phone:631-732-2639
Mailing Address - Fax:
Practice Address - Street 1:1 STADIUM RD.
Practice Address - Street 2:STONY BROOK UNIVERSITY STUDENT HEALTH SERVICE
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-3191
Practice Address - Country:US
Practice Address - Phone:631-632-6740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100008207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology