Provider Demographics
NPI:1598862864
Name:SHAHID MAHMOOD MD FAMILY PRACTICE PA
Entity Type:Organization
Organization Name:SHAHID MAHMOOD MD FAMILY PRACTICE PA
Other - Org Name:AL-SHIFA PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAHID
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHMOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-733-4496
Mailing Address - Street 1:1124 OPAL CT
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5940
Mailing Address - Country:US
Mailing Address - Phone:301-733-4496
Mailing Address - Fax:301-733-0963
Practice Address - Street 1:1124 OPAL CT
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5940
Practice Address - Country:US
Practice Address - Phone:301-733-4496
Practice Address - Fax:301-733-0963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063233207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408999500Medicaid
NCG79331Medicare UPIN