Provider Demographics
NPI:1174520936
Name:MAHMOOD, PARVEZ (MD)
Entity type:Individual
Prefix:DR
First Name:PARVEZ
Middle Name:
Last Name:MAHMOOD
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 1:20 HOSPITAL DR
Mailing Address - Street 2:SUITE 15
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6434
Mailing Address - Country:US
Mailing Address - Phone:732-286-6644
Mailing Address - Fax:732-286-9321
Practice Address - Street 1:20 HOSPITAL DR
Practice Address - Street 2:SUITE 15
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6434
Practice Address - Country:US
Practice Address - Phone:732-286-6644
Practice Address - Fax:732-286-9321
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02823000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ222843719OtherTAX ID
NJ534044BD9OtherMEDICARE ID
NJ0950106Medicaid
NJ31D0715825OtherCLIA
NJ0950106Medicaid