Provider Demographics
NPI:1548592983
Name:MAHMOOD, HAMID (CRNA)
Entity Type:Individual
Prefix:
First Name:HAMID
Middle Name:
Last Name:MAHMOOD
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 S SERVICE RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MEILVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:22033-2921
Mailing Address - Country:US
Mailing Address - Phone:804-289-4937
Mailing Address - Fax:516-945-3131
Practice Address - Street 1:1602 SKIPWITH RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-5205
Practice Address - Country:US
Practice Address - Phone:804-288-4453
Practice Address - Fax:804-288-1621
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168681367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ48171AOtherPALMETTO GBA MEDICARE