Provider Demographics
NPI: | 1710421607 |
---|---|
Name: | MOHAMED, AYMAN |
Entity Type: | Individual |
Prefix: | |
First Name: | AYMAN |
Middle Name: | |
Last Name: | MOHAMED |
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: | 4 SCIENCE PARK |
Mailing Address - Street 2: | 3RD FLOOR |
Mailing Address - City: | NEW HAVEN |
Mailing Address - State: | CT |
Mailing Address - Zip Code: | 06511-1962 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 203-787-7888 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4 SCIENCE PARK |
Practice Address - Street 2: | 3RD FLOOR |
Practice Address - City: | NEW HAVEN |
Practice Address - State: | CT |
Practice Address - Zip Code: | 06511-1962 |
Practice Address - Country: | US |
Practice Address - Phone: | 203-787-7888 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2016-12-12 |
Last Update Date: | 2016-12-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 247ZC0005X | Technologists, Technicians & Other Technical Service Providers | Technician, Pathology | Clinical Laboratory Director, Non-physician |
No | 246QH0000X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Pathology | Hematology |
No | 246QH0600X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Pathology | Histology |
No | 246QI0000X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Pathology | Immunology |
No | 246QL0900X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Pathology | Laboratory Management |
No | 246QM0706X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Pathology | Medical Technologist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CT | D300069332 | Medicare PIN |