Provider Demographics
NPI:1922075399
Name:SHAHED, MOHAMED M (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:M
Last Name:SHAHED
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 1:19050 LORAIN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-1915
Mailing Address - Country:US
Mailing Address - Phone:216-252-8000
Mailing Address - Fax:216-252-8117
Practice Address - Street 1:19050 LORAIN RD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-1915
Practice Address - Country:US
Practice Address - Phone:216-252-8000
Practice Address - Fax:216-252-8117
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35081431S207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
104899OtherKAISER
D368301OtherGROUP IND DIAGNOSTICS MED
1780634279OtherGROUP NPI
9273172OtherGROUP MEDICARE
CA4511OtherRR MEDICARE GROUP
P00266500OtherRR MEDICARE INDIVIDUAL
0119204OtherGROUP MEDICAID
11212974OtherCCAQH
3610861OtherGROUP ASC MEDICARE
9273172OtherGROUP MEDICAID
OH1952896250Medicaid
OH2341960Medicaid
11212974OtherCCAQH
34-1783789OtherGROUP TIN