Provider Demographics
NPI:1558466227
Name:MAHMUD, MOBUSHER (MD)
Entity Type:Individual
Prefix:
First Name:MOBUSHER
Middle Name:
Last Name:MAHMUD
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 1:5739 BOULDER RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-5453
Mailing Address - Country:US
Mailing Address - Phone:215-850-2698
Mailing Address - Fax:
Practice Address - Street 1:618 PLEASANTVILLE RD STE 101
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3325
Practice Address - Country:US
Practice Address - Phone:404-750-5017
Practice Address - Fax:740-653-7512
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GABA8388212207R00000X, 207RI0011X
GA066213207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0106797Medicaid