Provider Demographics
NPI:1811245822
Name:MAHMOOD, SYED HAZIQUE (MD)
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:HAZIQUE
Last Name:MAHMOOD
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 1:121 TOWNE SQUARE DR STE 301
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-9440
Mailing Address - Country:US
Mailing Address - Phone:717-988-8320
Mailing Address - Fax:717-221-5397
Practice Address - Street 1:121 TOWNE SQUARE DR STE 301
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-9440
Practice Address - Country:US
Practice Address - Phone:717-988-8320
Practice Address - Fax:717-221-5397
Is Sole Proprietor?:No
Enumeration Date:2012-08-22
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2693082081P2900X
PAMD4804492081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110120169AMedicaid