Provider Demographics
NPI:1801579073
Name:MEAD, MUSTAFA ABDURAHMAN
Entity type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:ABDURAHMAN
Last Name:MEAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 KNOB HL E
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-5404
Mailing Address - Country:US
Mailing Address - Phone:614-929-1028
Mailing Address - Fax:614-929-1028
Practice Address - Street 1:457 KNOB HL E
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-5404
Practice Address - Country:US
Practice Address - Phone:614-929-1028
Practice Address - Fax:614-929-1028
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSD043153343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)