Provider Demographics
NPI:1821142514
Name:MOHI-UD-DIN, GHULAM (MD)
Entity Type:Individual
Prefix:DR
First Name:GHULAM
Middle Name:
Last Name:MOHI-UD-DIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:G.
Other - Middle Name:M
Other - Last Name:DIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6510 KENILWORTH AVENUE
Mailing Address - Street 2:SUITE 2600
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1339
Mailing Address - Country:US
Mailing Address - Phone:301-277-6565
Mailing Address - Fax:301-699-3956
Practice Address - Street 1:6510 KENILWORTH AVE
Practice Address - Street 2:SUITE 2600
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1339
Practice Address - Country:US
Practice Address - Phone:301-277-6565
Practice Address - Fax:301-699-3956
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0022549207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD796081600Medicaid
MD179086Medicare ID - Type Unspecified
MD796081600Medicaid