Provider Demographics
NPI:1396073359
Name:MOHAMED B. ASWAD, MD PC
Entity type:Organization
Organization Name:MOHAMED B. ASWAD, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:BASEL
Authorized Official - Last Name:ASWAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-546-3750
Mailing Address - Street 1:PO BOX 510
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88031-0510
Mailing Address - Country:US
Mailing Address - Phone:575-546-3750
Mailing Address - Fax:575-546-2770
Practice Address - Street 1:1020 S 8TH ST
Practice Address - Street 2:STE. B
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-4007
Practice Address - Country:US
Practice Address - Phone:575-546-3750
Practice Address - Fax:575-546-2770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-01
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2003-0043207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMH95172Medicare UPIN