Provider Demographics
NPI:1437443637
Name:MOHAMED, AMBREEN (MD)
Entity Type:Individual
Prefix:MS
First Name:AMBREEN
Middle Name:
Last Name:MOHAMED
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 1:1605 N CEDAR CREST BLVD STE 411
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2323
Mailing Address - Country:US
Mailing Address - Phone:610-969-1915
Mailing Address - Fax:484-664-7659
Practice Address - Street 1:205 E LAUREL BLVD
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-2534
Practice Address - Country:US
Practice Address - Phone:570-622-1887
Practice Address - Fax:570-622-1959
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCDRH.0070015207RC0000X
CT053710207R00000X
TXU2400207RC0000X
CAA170133207RC0000X
PAMD459649207RC0000X
WAIMLC.MD.61411309207RC0000X
NC2023-03321207RC0000X
GA94876207RC0000X
AZ69408207RC0000X
MA1017084207RC0000X
NY281652207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine