Provider Demographics
NPI:1598742017
Name:ADAM, MAHMOUD H (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHMOUD
Middle Name:H
Last Name:ADAM
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 1:1351 PINE ST
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-4260
Mailing Address - Country:US
Mailing Address - Phone:239-304-9267
Mailing Address - Fax:239-304-9276
Practice Address - Street 1:1351 PINE ST
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-4260
Practice Address - Country:US
Practice Address - Phone:239-304-9267
Practice Address - Fax:239-304-9276
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-033073207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000325278OtherANTHEM
OH0163184Medicaid
OH0683736Medicare ID - Type Unspecified
OH0163184Medicaid