Provider Demographics
NPI:1750488631
Name:ISLAM, MOHAMMED N (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:N
Last Name:ISLAM
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 1:9 NORTH 7TH STREET
Mailing Address - Street 2:SUITE 203
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-1880
Mailing Address - Country:US
Mailing Address - Phone:724-357-7196
Mailing Address - Fax:724-357-7279
Practice Address - Street 1:1265 WAYNE AVE
Practice Address - Street 2:119 PROF. BLDG, SUITE 103
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3501
Practice Address - Country:US
Practice Address - Phone:724-463-1046
Practice Address - Fax:724-463-2314
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD436442208600000X, 2086S0129X
NY1958042086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01663309Medicaid
NYRB8636Medicare PIN
NY01663309Medicaid
NY168451Medicare PIN