Provider Demographics
NPI:1073727350
Name:NOUR, MOHAMED K (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:K
Last Name:NOUR
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 1:8811 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-2039
Mailing Address - Country:US
Mailing Address - Phone:718-847-4222
Mailing Address - Fax:718-441-4117
Practice Address - Street 1:8811 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-2039
Practice Address - Country:US
Practice Address - Phone:718-847-4222
Practice Address - Fax:718-441-4117
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2010-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126616174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06574Medicare ID - Type Unspecified