Provider Demographics
NPI:1972972776
Name:MOHAMMED S. QAYYUM, MD
Entity Type:Organization
Organization Name:MOHAMMED S. QAYYUM, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASST.
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-298-0434
Mailing Address - Street 1:4585 STEVENS CREEK BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-6700
Mailing Address - Country:US
Mailing Address - Phone:408-298-0433
Mailing Address - Fax:
Practice Address - Street 1:4585 STEVENS CREEK BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-6700
Practice Address - Country:US
Practice Address - Phone:408-298-0433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56213207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH22561Medicare UPIN