Provider Demographics
NPI:1437202561
Name:SHAMSI, MAHMOOD AHMED (MD)
Entity Type:Individual
Prefix:
First Name:MAHMOOD
Middle Name:AHMED
Last Name:SHAMSI
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 1:14 CONCORD AVE
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-5233
Mailing Address - Country:US
Mailing Address - Phone:732-572-8956
Mailing Address - Fax:732-339-0088
Practice Address - Street 1:1273 BOUND BROOK RD
Practice Address - Street 2:
Practice Address - City:MIDDLESEX
Practice Address - State:NJ
Practice Address - Zip Code:08846-1490
Practice Address - Country:US
Practice Address - Phone:732-563-6630
Practice Address - Fax:732-563-6733
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA5799400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ020126Medicare ID - Type Unspecified
NJF45408Medicare UPIN