Provider Demographics
NPI:1356911655
Name:MAHMOOD, HUSSAM (DO)
Entity type:Individual
Prefix:
First Name:HUSSAM
Middle Name:
Last Name:MAHMOOD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:36 S RIVER RD
Practice Address - Street 2:
Practice Address - City:HALIFAX
Practice Address - State:PA
Practice Address - Zip Code:17032-8614
Practice Address - Country:US
Practice Address - Phone:717-827-3428
Practice Address - Fax:717-827-3437
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS024024207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1039193020002Medicaid
PA6U8151OtherMEDICARE