Provider Demographics
NPI:1326044926
Name:ALAM, MAQSOOD (MD)
Entity Type:Individual
Prefix:
First Name:MAQSOOD
Middle Name:
Last Name:ALAM
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 1:27 MIDDLE LN
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2235
Mailing Address - Country:US
Mailing Address - Phone:516-974-5177
Mailing Address - Fax:516-678-2465
Practice Address - Street 1:27 MIDDLE LN
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2235
Practice Address - Country:US
Practice Address - Phone:516-974-5177
Practice Address - Fax:516-678-2465
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233680207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02780514Medicaid
NY02780514Medicaid
2X6611Medicare PIN