Provider Demographics
NPI:1457474645
Name:MAHMOOD, QASIM (MD)
Entity Type:Individual
Prefix:DR
First Name:QASIM
Middle Name:
Last Name:MAHMOOD
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 1:1201 GRAMPIAN BLVD
Mailing Address - Street 2:SUITE 1K
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 HIGH ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3198
Practice Address - Country:US
Practice Address - Phone:570-321-2810
Practice Address - Fax:570-321-2811
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD434379208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA003173OtherFIRST PRIORITY HEALTH - PCP
PA9677144OtherAETNA
PA2042685OtherHIGHMARK BLUE SHIELD
PA823442OtherFIRST PRIORITY HEALTH - SPECIALIST/HOSPITALIST
PA1021671410001Medicaid
PA9677144OtherAETNA