Provider Demographics
NPI:1457569196
Name:MAHMOOD, FAISAL (MD)
Entity Type:Individual
Prefix:MR
First Name:FAISAL
Middle Name:
Last Name:MAHMOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 HAMBURG TPKE STE 202
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2166
Mailing Address - Country:US
Mailing Address - Phone:973-870-0777
Mailing Address - Fax:888-972-9734
Practice Address - Street 1:342 HAMBURG TPKE STE 202
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2166
Practice Address - Country:US
Practice Address - Phone:973-870-0777
Practice Address - Fax:888-972-9734
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MA08833300207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program