Provider Demographics
NPI:1619154358
Name:MEHMOOD, MUDDASSIR (MD)
Entity type:Individual
Prefix:
First Name:MUDDASSIR
Middle Name:
Last Name:MEHMOOD
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 1:1940 ALCOA HWY STE E310
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-2267
Mailing Address - Country:US
Mailing Address - Phone:865-544-2800
Mailing Address - Fax:865-544-6812
Practice Address - Street 1:1940 ALCOA HWY STE E310
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-2267
Practice Address - Country:US
Practice Address - Phone:865-544-2800
Practice Address - Fax:865-544-6812
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN56781207RC0000X, 207RA0001X, 207RA0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC2790Medicaid
NC1619154358Medicaid
OH3072571Medicaid
NC1619154358Medicaid
NCNCT480CMedicare PIN
NCNCT480BMedicare PIN
OH4298341Medicare PIN
SCNC2790Medicaid