Provider Demographics
NPI:1376544403
Name:MOHSIN, INTIKHAB (MD)
Entity Type:Individual
Prefix:
First Name:INTIKHAB
Middle Name:
Last Name:MOHSIN
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 1:46 YORKSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-1328
Mailing Address - Country:US
Mailing Address - Phone:518-451-9239
Mailing Address - Fax:
Practice Address - Street 1:113 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3410
Practice Address - Country:US
Practice Address - Phone:518-626-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33419207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1227496Medicaid
IA30117OtherBLUE CROSS
IA050083665OtherRAILROAD MEDICARE
IA050083665OtherRAILROAD MEDICARE
IAI4979Medicare ID - Type Unspecified