Provider Demographics
NPI:1780787028
Name:MAHMUD, RIFFAT S (MD)
Entity type:Individual
Prefix:
First Name:RIFFAT
Middle Name:S
Last Name:MAHMUD
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:PO BOX 537
Mailing Address - Street 2:
Mailing Address - City:PARKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21120-0537
Mailing Address - Country:US
Mailing Address - Phone:717-909-4928
Mailing Address - Fax:717-564-3135
Practice Address - Street 1:1850 NORMANDIE DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-1534
Practice Address - Country:US
Practice Address - Phone:717-741-5959
Practice Address - Fax:717-741-4395
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053502L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014862170004Medicaid
PA532532Medicare PIN
PADN6880Medicare PIN
PA0014862170004Medicaid
PA080185752Medicare PIN
PA532532VJ9Medicare PIN