Provider Demographics
NPI:1760416457
Name:MOHAMMAD INAYATULLAH MD PA
Entity Type:Organization
Organization Name:MOHAMMAD INAYATULLAH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:INAYATULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-727-5447
Mailing Address - Street 1:301 ST PAUL PLACE
Mailing Address - Street 2:SUITE 620
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202
Mailing Address - Country:US
Mailing Address - Phone:410-727-5447
Mailing Address - Fax:410-727-5456
Practice Address - Street 1:301 ST PAUL PLACE
Practice Address - Street 2:SUITE 620
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202
Practice Address - Country:US
Practice Address - Phone:410-727-5447
Practice Address - Fax:410-727-5456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0005353207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B67866Medicare UPIN
MD110PMedicare PIN