Provider Demographics
NPI:1346228012
Name:MAHMOOD, SHAKEER (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAKEER
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:PO BOX 5548
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-1509
Mailing Address - Country:US
Mailing Address - Phone:704-866-0101
Mailing Address - Fax:704-866-0103
Practice Address - Street 1:211 S CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-7177
Practice Address - Country:US
Practice Address - Phone:704-866-0101
Practice Address - Fax:704-866-0103
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC99-00093207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1202TOtherBLUE CROSS BLUE SHIELD #
NC891202TMedicaid
NC2271345Medicare ID - Type Unspecified
NCG91934Medicare UPIN