Provider Demographics
NPI:1265964191
Name:MOHAMED, SHAZA R (MD)
Entity type:Individual
Prefix:
First Name:SHAZA
Middle Name:R
Last Name:MOHAMED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1101 MEDICAL CENTER BLVD
Mailing Address - Street 2:ATTN: MEDICAL STAFF OFFICE
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072
Mailing Address - Country:US
Mailing Address - Phone:504-349-1297
Mailing Address - Fax:504-349-1146
Practice Address - Street 1:1101 MEDICAL CENTER BLVD
Practice Address - Street 2:4 WEST
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072
Practice Address - Country:US
Practice Address - Phone:504-349-1656
Practice Address - Fax:504-349-1933
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
LAMD.305408207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program