Provider Demographics
NPI:1376693051
Name:MAISAMI, MOHAMMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:
Last Name:MAISAMI
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 1:26 W PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-5027
Mailing Address - Country:US
Mailing Address - Phone:410-321-7907
Mailing Address - Fax:410-321-0337
Practice Address - Street 1:26 W PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-5001
Practice Address - Country:US
Practice Address - Phone:410-321-7907
Practice Address - Fax:410-321-0337
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00189152084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0018915OtherMEDICAL LICENSE
MD459141100Medicaid
MDMO5471OtherMD CONTROL SBSTANCE
MDMO5471OtherMD CONTROL SBSTANCE
MD459141100Medicaid