Provider Demographics
NPI:1700847985
Name:RAHMAN, MOHAMMAD R (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:R
Last Name:RAHMAN
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 1:111 CLYDE ST
Mailing Address - Street 2:
Mailing Address - City:LOUDON
Mailing Address - State:TN
Mailing Address - Zip Code:37774-1566
Mailing Address - Country:US
Mailing Address - Phone:865-458-1554
Mailing Address - Fax:865-458-1762
Practice Address - Street 1:111 CLYDE ST
Practice Address - Street 2:
Practice Address - City:LOUDON
Practice Address - State:TN
Practice Address - Zip Code:37774-1566
Practice Address - Country:US
Practice Address - Phone:865-458-1554
Practice Address - Fax:865-458-1762
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD13686207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3188787Medicaid
TN3188787Medicaid