Provider Demographics
NPI:1033210893
Name:MOHAMED, SHARAB (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARAB
Middle Name:
Last Name:MOHAMED
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 1:3345 JOG RD
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2010
Mailing Address - Country:US
Mailing Address - Phone:561-965-0813
Mailing Address - Fax:561-965-7505
Practice Address - Street 1:3345 JOG RD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33467-2010
Practice Address - Country:US
Practice Address - Phone:561-965-0813
Practice Address - Fax:561-965-7505
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00064608207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0402795OtherUNITED HEALTH CARE ID
FL33186OtherBCBS GROUP ID
FL650518562OtherVISTA HEALTH CARE ID
FL650518562OtherFED ID FOR ALL OTHER COMM
FL241798OtherAVMED INDIVIDUAL ID
FL650518562OtherGHI INSURANCE ID
FL964625OtherAETNA HEALTH INSURANCE ID
FL23558OtherBLUE CROSS BLUE SHIELD ID
FL262403600Medicaid
FL650518562OtherTOTAL HEALTH CHOICE ID
FL650518562OtherCHAMPUS ID
FL375690400Medicaid
FL964625OtherAETNA HEALTH INSURANCE ID
FL650518562OtherVISTA HEALTH CARE ID
FL23558ZMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL ID