Provider Demographics
NPI:1578269551
Name:MOHAMMAD, DHERAR JASSIM
Entity Type:Individual
Prefix:
First Name:DHERAR
Middle Name:JASSIM
Last Name:MOHAMMAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3753 MOSSBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514-1605
Mailing Address - Country:US
Mailing Address - Phone:859-408-0584
Mailing Address - Fax:
Practice Address - Street 1:3753 MOSSBRIDGE WAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40514-1605
Practice Address - Country:US
Practice Address - Phone:859-408-0584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)