Provider Demographics
NPI:1427015619
Name:MAHMOOD, FAUZIA (MD)
Entity Type:Individual
Prefix:
First Name:FAUZIA
Middle Name:
Last Name:MAHMOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 SYLVAN WAY
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-1332
Mailing Address - Country:US
Mailing Address - Phone:973-316-1982
Mailing Address - Fax:973-299-7212
Practice Address - Street 1:76 BROADWAY
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2764
Practice Address - Country:US
Practice Address - Phone:973-316-1982
Practice Address - Fax:973-299-7212
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA043018002084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ441644Medicare ID - Type Unspecified