Provider Demographics
NPI:1760541312
Name:KAWAM, MOHAMED (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:
Last Name:KAWAM
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:PO BOX 3400
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07474-3400
Mailing Address - Country:US
Mailing Address - Phone:973-942-3200
Mailing Address - Fax:973-942-2901
Practice Address - Street 1:160 HALEDON AVE
Practice Address - Street 2:
Practice Address - City:PROSPECT PARK
Practice Address - State:NJ
Practice Address - Zip Code:07508-2051
Practice Address - Country:US
Practice Address - Phone:973-942-3200
Practice Address - Fax:973-942-2901
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06054400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0527024OtherAETNA HMO#
NJ3K3301OtherHEALTHNET #
NJ01000019400OtherAMERICHOICE#
NJ395AD1OtherEMPIRE BC/BS NY
NJ5503390OtherGHI PPO#
NJP00311542OtherRR MDCR #
NJ4592906OtherAETNA PPO#
NJ1081846OtherHORIZON NJ HEALTH#
NJ0551037000OtherAMERIHEALTH#
NJ12129OtherUNIVERSITY HEALTH PLANS #
NJP2145955OtherOXFORD#
NJ12189OtherAMERIGROUP#
NJ223521353OtherTAX ID#
NJ6274501Medicaid
NJ5503390OtherGHI PPO#
NJ6274501Medicaid