Provider Demographics
NPI:1962848457
Name:MOHAMED, BETHANN (MD)
Entity Type:Individual
Prefix:
First Name:BETHANN
Middle Name:
Last Name:MOHAMED
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 1:90 HOWE ST.
Mailing Address - Street 2:UNIT B
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511
Mailing Address - Country:US
Mailing Address - Phone:954-732-3143
Mailing Address - Fax:
Practice Address - Street 1:333 CEDAR ST.
Practice Address - Street 2:YALE MEDICAL SCHOOL
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-688-2259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-11
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1.055730207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine