Provider Demographics
NPI:1265622195
Name:USMAN, MOHAMMED H (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:H
Last Name:USMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MOHAMMED HARIS
Other - Middle Name:UMER
Other - Last Name:USMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2601 HOLME AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2007
Mailing Address - Country:US
Mailing Address - Phone:732-608-9737
Mailing Address - Fax:732-608-9744
Practice Address - Street 1:599 ROUTE 37 W
Practice Address - Street 2:SUITE# 5
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8011
Practice Address - Country:US
Practice Address - Phone:732-608-9737
Practice Address - Fax:732-608-9744
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09932400207RI0011X, 207RC0000X
PAMD429462207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019668780001Medicaid
PAP00625318Medicare PIN
PA1019668780001Medicaid