Provider Demographics
NPI:1831705375
Name:MASOUD, MOHAMED K
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:K
Last Name:MASOUD
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 1:2049 OAK TREE DR E
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-2458
Mailing Address - Country:US
Mailing Address - Phone:937-789-7900
Mailing Address - Fax:
Practice Address - Street 1:2049 OAK TREE DR E
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-2458
Practice Address - Country:US
Practice Address - Phone:937-789-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide