Provider Demographics
NPI:1073575288
Name:PATHAN, MOHAMMED Y (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:Y
Last Name:PATHAN
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 1:2101 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-8806
Mailing Address - Country:US
Mailing Address - Phone:706-221-8799
Mailing Address - Fax:706-221-8979
Practice Address - Street 1:2101 NORTH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-8806
Practice Address - Country:US
Practice Address - Phone:706-221-8799
Practice Address - Fax:706-221-8979
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00557622084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDW6620163OtherCAREFIRST
DC0163OtherCAREFIRST
MDK519164537901OtherCAREFIRST
I02294Medicare UPIN
MDK519H983Medicare ID - Type Unspecified