Provider Demographics
NPI:1578731212
Name:ALMUBASLAT, MOHAMMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:
Last Name:ALMUBASLAT
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 1:100 MARINERS BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-6815
Mailing Address - Country:US
Mailing Address - Phone:985-400-3210
Mailing Address - Fax:855-553-6931
Practice Address - Street 1:100 MARINERS BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-6815
Practice Address - Country:US
Practice Address - Phone:985-400-3210
Practice Address - Fax:855-553-6931
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.200761207T00000X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology