Provider Demographics
NPI:1689860215
Name:MOAWAD ELNAA, MAHMOUD AHMED (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHMOUD
Middle Name:AHMED
Last Name:MOAWAD ELNAA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MAHMOUD
Other - Middle Name:A
Other - Last Name:MOAWAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1611 CAMBRIDGE ST
Mailing Address - Street 2:INTERNAL MEDICINE
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4302
Mailing Address - Country:US
Mailing Address - Phone:617-661-5100
Mailing Address - Fax:
Practice Address - Street 1:1611 CAMBRIDGE ST
Practice Address - Street 2:HARVARD VANGUARD MEDICAL ASSOCIATES
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138
Practice Address - Country:US
Practice Address - Phone:617-661-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041131L207R00000X
MA234347207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2161053Medicaid
MA000805401Medicare PIN