Provider Demographics
NPI:1164607669
Name:MASOOD, AWAIS (MD)
Entity Type:Individual
Prefix:
First Name:AWAIS
Middle Name:
Last Name:MASOOD
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 1:8224 242ND STREET
Mailing Address - Street 2:
Mailing Address - City:BELLEROSE
Mailing Address - State:NY
Mailing Address - Zip Code:11426
Mailing Address - Country:US
Mailing Address - Phone:786-853-7813
Mailing Address - Fax:
Practice Address - Street 1:8224 242ND STREET
Practice Address - Street 2:
Practice Address - City:BELLEROSE
Practice Address - State:NY
Practice Address - Zip Code:11426
Practice Address - Country:US
Practice Address - Phone:786-853-7813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME119196207RE0101X
TXR0074207R00000X
NC2010-01843207R00000X, 208M00000X
GA71715207RE0101X
IN01077517A207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1164607669Medicaid
NC5916608Medicaid
SCNC1266Medicaid
NC2076875AMedicare PIN
NC5916608Medicaid