Provider Demographics
NPI:1417568650
Name:MOHAMED, MOHAMOUD A
Entity Type:Individual
Prefix:
First Name:MOHAMOUD
Middle Name:A
Last Name:MOHAMED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:486 DAVENTRY LN
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-2369
Mailing Address - Country:US
Mailing Address - Phone:614-795-7680
Mailing Address - Fax:
Practice Address - Street 1:486 DAVENTRY LN
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-2369
Practice Address - Country:US
Practice Address - Phone:614-795-7680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)