Provider Demographics
NPI:1467513424
Name:KAMRAN, MUHAMMAD T (MD)
Entity type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:T
Last Name:KAMRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5 BROOKVALE LN
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-2708
Mailing Address - Country:US
Mailing Address - Phone:917-496-1946
Mailing Address - Fax:718-264-4622
Practice Address - Street 1:111 SYLVAN AVE
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-2420
Practice Address - Country:US
Practice Address - Phone:631-928-4888
Practice Address - Fax:631-928-4889
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY223562208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02340696Medicaid
NY06985Medicare ID - Type Unspecified
NY02340696Medicaid