Provider Demographics
NPI:1598756298
Name:EL-MASRI, MOHAMAD (MD)
Entity Type:Individual
Prefix:MR
First Name:MOHAMAD
Middle Name:
Last Name:EL-MASRI
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 1:8220 MEADOWBRIDGE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-2336
Mailing Address - Country:US
Mailing Address - Phone:804-764-1253
Mailing Address - Fax:804-764-1259
Practice Address - Street 1:8220 MEADOWBRIDGE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2336
Practice Address - Country:US
Practice Address - Phone:804-764-1253
Practice Address - Fax:804-764-1259
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236760207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC07050OtherGROUP PTAN
VA010198607Medicaid
VAC06115OtherGROUP PTAN
VAC06778OtherGROUP PTAN
VA008340V16Medicare ID - Type Unspecified
VAC06115OtherGROUP PTAN