Provider Demographics
NPI:1467447805
Name:MASOOD, SAQIB (MD)
Entity Type:Individual
Prefix:
First Name:SAQIB
Middle Name:
Last Name:MASOOD
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 1:20001 FARMINGDALE CT
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-4056
Mailing Address - Country:US
Mailing Address - Phone:301-739-1957
Mailing Address - Fax:
Practice Address - Street 1:319 E ANTIETAM ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5701
Practice Address - Country:US
Practice Address - Phone:301-790-3620
Practice Address - Fax:301-797-2863
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061269208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405095900Medicaid
MD405095900Medicaid