Provider Demographics
NPI:1619339165
Name:MAHMOOD, FIRAS
Entity Type:Individual
Prefix:
First Name:FIRAS
Middle Name:
Last Name:MAHMOOD
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 1:203 E SCHROCK RD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-3448
Mailing Address - Country:US
Mailing Address - Phone:614-313-7374
Mailing Address - Fax:614-427-5591
Practice Address - Street 1:203 E. SCHROCK RD.
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081
Practice Address - Country:US
Practice Address - Phone:614-313-7374
Practice Address - Fax:614-427-5591
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0135468171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0135468Medicaid