Provider Demographics
NPI:1770859514
Name:MAHDI, NICOLE DOMINIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:DOMINIQUE
Last Name:MAHDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5051 GREENSPRING AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4357
Mailing Address - Country:US
Mailing Address - Phone:410-601-9515
Mailing Address - Fax:
Practice Address - Street 1:5051 GREENSPRING AVE STE 200
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-4357
Practice Address - Country:US
Practice Address - Phone:410-601-9515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00832892084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology