Provider Demographics
NPI:1376537407
Name:KANJWAL, MOHAMMED YOUSEF (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:YOUSEF
Last Name:KANJWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2401 WEST BELVEDERE AVENUE
Mailing Address - Street 2:DEPARTMENT OF CREDENTIALING
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215
Mailing Address - Country:US
Mailing Address - Phone:410-601-5524
Mailing Address - Fax:410-601-8946
Practice Address - Street 1:5051 GREENSPRING AVENUE
Practice Address - Street 2:SUITE 304
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209
Practice Address - Country:US
Practice Address - Phone:410-601-9355
Practice Address - Fax:410-601-8704
Is Sole Proprietor?:No
Enumeration Date:2005-09-05
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35078130207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2195557Medicaid
G44488Medicare UPIN
KA4022294Medicare ID - Type Unspecified