Provider Demographics
NPI:1043238553
Name:MAHMOUD, AHMED (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMED
Middle Name:
Last Name:MAHMOUD
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 1:613 S HIGHWAY 78 STE 200
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-5525
Mailing Address - Country:US
Mailing Address - Phone:469-562-4232
Mailing Address - Fax:972-201-9656
Practice Address - Street 1:613 S HIGHWAY 78 STE 200
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-5525
Practice Address - Country:US
Practice Address - Phone:469-562-4232
Practice Address - Fax:972-201-9656
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA227525208100000X
WV23594208100000X
TXQ8294208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
7956672OtherAETNA
MA96501601OtherNETWORK
96501601OtherNETWORK
202705274OtherUHP
RI32024OtherNHP
524095OtherFALLON
RI611000601OtherDOL
MA611000600OtherDOL
RI413611OtherBLUE CHIP
875014OtherCIGNA
AA49931OtherHPHC
AA49937OtherHPHC
RIAM64251Medicaid
MA2121433Medicaid
RI31700OtherBCBS
202705274OtherGREAT WEST
448534OtherTUFTS
MAJ40435OtherBCBS
524095OtherFALLON
AA49937OtherHPHC
96501601OtherNETWORK