Provider Demographics
NPI:1659682110
Name:MAHMOUD, NERVANA T (MD)
Entity type:Individual
Prefix:
First Name:NERVANA
Middle Name:T
Last Name:MAHMOUD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 KOLTER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3570
Mailing Address - Country:US
Mailing Address - Phone:724-349-8311
Mailing Address - Fax:724-349-8331
Practice Address - Street 1:15 S 8TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-2776
Practice Address - Country:US
Practice Address - Phone:724-349-8311
Practice Address - Fax:724-349-8331
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD452693207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine