Provider Demographics
NPI:1639322332
Name:MOHAMED, IGBAL ELAMIN (PA)
Entity Type:Individual
Prefix:
First Name:IGBAL
Middle Name:ELAMIN
Last Name:MOHAMED
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 HOLLIS ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1235
Mailing Address - Country:US
Mailing Address - Phone:603-626-9500
Mailing Address - Fax:603-626-9523
Practice Address - Street 1:145 HOLLIS ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1235
Practice Address - Country:US
Practice Address - Phone:603-626-9500
Practice Address - Fax:603-626-9523
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0695363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH02-0348711OtherCHILD HEALTH SERVICES