Provider Demographics
NPI:1720366552
Name:SAID MAHMOUDIAN, HOSSAIN (MD)
Entity Type:Individual
Prefix:
First Name:HOSSAIN
Middle Name:
Last Name:SAID MAHMOUDIAN
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 1:6507 DEER POINTE DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-1667
Mailing Address - Country:US
Mailing Address - Phone:410-543-9332
Mailing Address - Fax:410-543-9237
Practice Address - Street 1:6507 DEER POINTE DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1667
Practice Address - Country:US
Practice Address - Phone:410-543-9332
Practice Address - Fax:410-543-9237
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-27
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD0080916208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD874043700Medicaid