Provider Demographics
NPI:1669448700
Name:INAYATULLAH, MOHAMMAD
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:
Last Name:INAYATULLAH
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 1:301 ST. PAUL PLACE
Mailing Address - Street 2:SUITE 620
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202
Mailing Address - Country:US
Mailing Address - Phone:410-727-5447
Mailing Address - Fax:410-727-5456
Practice Address - Street 1:301 SAINT PAUL PL
Practice Address - Street 2:SUITE 620
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2102
Practice Address - Country:US
Practice Address - Phone:410-727-5447
Practice Address - Fax:410-727-5456
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD05353207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD110P301GMedicare PIN