Provider Demographics
NPI:1639166358
Name:MALAYERI, MAHMOUD (MD)
Entity Type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:
Last Name:MALAYERI
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 1:828 AIRPAX RD
Mailing Address - Street 2:SUITE 300B
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-6405
Mailing Address - Country:US
Mailing Address - Phone:410-228-3929
Mailing Address - Fax:410-228-3810
Practice Address - Street 1:805 N SALISBURY BLVD
Practice Address - Street 2:STE 3100
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-3637
Practice Address - Country:US
Practice Address - Phone:410-334-6687
Practice Address - Fax:410-334-6700
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00187372084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B70420Medicare UPIN
MD836LP137Medicare ID - Type UnspecifiedMEDICARE PROVIDER