Provider Demographics
NPI:1326126780
Name:MOHAMED, IQBAL A (MD)
Entity Type:Individual
Prefix:
First Name:IQBAL
Middle Name:A
Last Name:MOHAMED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 COLOMBA DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14305-1205
Mailing Address - Country:US
Mailing Address - Phone:716-285-3464
Mailing Address - Fax:716-285-8520
Practice Address - Street 1:1 COLOMBA DR
Practice Address - Street 2:SUITE 2
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14305-1205
Practice Address - Country:US
Practice Address - Phone:716-285-3464
Practice Address - Fax:716-285-8520
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2011-07-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY0609982208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00606551Medicaid
NY00010120601OtherUNIVERA
NY000502232001OtherBLUE CROSS BLUE SHIELD
NY040426003459OtherFIDELIS
NY161136388OtherTAX ID
NY1900695OtherINDEPENDENT HEALTH
NY161136388OtherTAX ID
NY040426003459OtherFIDELIS
NY1900695OtherINDEPENDENT HEALTH