Provider Demographics
NPI:1730471459
Name:GUENENA, MOHAMED A (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:A
Last Name:GUENENA
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 1:6 TSIENNETO RD STE 101
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-1584
Mailing Address - Country:US
Mailing Address - Phone:603-434-4193
Mailing Address - Fax:603-437-6804
Practice Address - Street 1:6 TSIENNETO RD STE 101
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-1584
Practice Address - Country:US
Practice Address - Phone:603-434-4193
Practice Address - Fax:603-437-6804
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR1379207W00000X
390200000X
NH20397207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program