Provider Demographics
NPI:1164610317
Name:MOUHAMAD O. ANNOUS, MD PA
Entity Type:Organization
Organization Name:MOUHAMAD O. ANNOUS, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOUHAMAD
Authorized Official - Middle Name:O
Authorized Official - Last Name:ANNOUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-323-9214
Mailing Address - Street 1:7801 YORK RD STE 240
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7446
Mailing Address - Country:US
Mailing Address - Phone:410-323-9214
Mailing Address - Fax:410-323-9215
Practice Address - Street 1:7801 YORK RD STE 240
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:410-323-9214
Practice Address - Fax:410-323-9215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00234272086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD129241200Medicaid
MDKEP5/35191001OtherBLUE SHIELD
MD595MMedicare PIN