Provider Demographics
NPI:1568659985
Name:ALAM, MAHMUDA AKHTER (MD)
Entity Type:Individual
Prefix:
First Name:MAHMUDA
Middle Name:AKHTER
Last Name:ALAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 N JACKSON ST
Mailing Address - Street 2:# B
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-2015
Mailing Address - Country:US
Mailing Address - Phone:646-244-2962
Mailing Address - Fax:
Practice Address - Street 1:715 N JACKSON ST
Practice Address - Street 2:# B
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-2015
Practice Address - Country:US
Practice Address - Phone:646-244-2962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-30
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 95563207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine