Provider Demographics
NPI:1245956606
Name:MAHMOUD, AHMAD ALI
Entity type:Individual
Prefix:
First Name:AHMAD
Middle Name:ALI
Last Name:MAHMOUD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 E RIVER RD NE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-3448
Mailing Address - Country:US
Mailing Address - Phone:507-319-1773
Mailing Address - Fax:507-206-4733
Practice Address - Street 1:2540 E RIVER RD NE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906-3448
Practice Address - Country:US
Practice Address - Phone:507-319-1773
Practice Address - Fax:507-206-4733
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)