Provider Demographics
NPI:1700828233
Name:MOHAMADI, MAHMOOD (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHMOOD
Middle Name:
Last Name:MOHAMADI
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 1:6130 OXON HILL RD
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3103
Mailing Address - Country:US
Mailing Address - Phone:301-567-9570
Mailing Address - Fax:301-567-5290
Practice Address - Street 1:6130 OXON HILL RD
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3103
Practice Address - Country:US
Practice Address - Phone:301-567-9570
Practice Address - Fax:301-567-5290
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD14619207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
021842700OtherMEDICAID OF D.C.
MD002681600Medicaid
MDC88757Medicare UPIN
021842700OtherMEDICAID OF D.C.