Provider Demographics
NPI:1285630111
Name:MOHIUDDIN, MASARRAT (MD)
Entity Type:Individual
Prefix:
First Name:MASARRAT
Middle Name:
Last Name:MOHIUDDIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 BRISTOL PATH LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4481
Mailing Address - Country:US
Mailing Address - Phone:281-778-0120
Mailing Address - Fax:
Practice Address - Street 1:6210 BRISTOL PATH LN
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-4481
Practice Address - Country:US
Practice Address - Phone:281-778-0120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000045040OtherANTHEM
KY64207459Medicaid
KY000000045040OtherANTHEM
KY0538745Medicare ID - Type UnspecifiedPX
KY0249407Medicare ID - Type UnspecifiedPO
KY0538461Medicare ID - Type UnspecifiedEB
KY64207459Medicaid
KY0538544Medicare ID - Type UnspecifiedFD