Provider Demographics
NPI:1205935087
Name:MAHMUD, SAEEDA A (MD)
Entity type:Individual
Prefix:
First Name:SAEEDA
Middle Name:A
Last Name:MAHMUD
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 1:10 HEALTHY WAY
Mailing Address - Street 2:
Mailing Address - City:ELLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12428-5612
Mailing Address - Country:US
Mailing Address - Phone:845-647-2510
Mailing Address - Fax:845-647-2975
Practice Address - Street 1:10 HEALTHY WAY
Practice Address - Street 2:
Practice Address - City:ELLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12428-5612
Practice Address - Country:US
Practice Address - Phone:845-647-2510
Practice Address - Fax:845-647-2975
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189663207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01574423Medicaid
NYA400063517OtherPTAN
NY15J511Medicare PIN
F81993Medicare UPIN