Provider Demographics
NPI:1538320130
Name:MAHMOOD, HUMA
Entity Type:Individual
Prefix:
First Name:HUMA
Middle Name:
Last Name:MAHMOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 FORREST AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-2251
Mailing Address - Country:US
Mailing Address - Phone:610-667-6465
Mailing Address - Fax:888-598-7517
Practice Address - Street 1:111 FORREST AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-2251
Practice Address - Country:US
Practice Address - Phone:610-667-6465
Practice Address - Fax:888-598-7517
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAOT0127252084P0804X
PAOS0156712084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program