Provider Demographics
NPI:1124210026
Name:DAUDA, MOHAMED SHEKU (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:SHEKU
Last Name:DAUDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MOHAMED
Other - Middle Name:SHEKU
Other - Last Name:DAUDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2000 W BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21223-1558
Mailing Address - Country:US
Mailing Address - Phone:410-362-4068
Mailing Address - Fax:410-362-3312
Practice Address - Street 1:2000 W BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-1558
Practice Address - Country:US
Practice Address - Phone:410-362-4068
Practice Address - Fax:410-362-3312
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD75411207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC147K0OtherBCBS
NC5908174Medicaid
NC5908174Medicaid
NC147K0OtherBCBS