Provider Demographics
NPI:1952925950
Name:ISLAM, MOHAMMAD KHAYRUL (MD, DPM)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:KHAYRUL
Last Name:ISLAM
Suffix:
Gender:M
Credentials:MD, DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3554 HULMEVILLE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-4366
Mailing Address - Country:US
Mailing Address - Phone:215-245-1818
Mailing Address - Fax:215-245-9129
Practice Address - Street 1:3554 HULMEVILLE RD STE 104
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-4366
Practice Address - Country:US
Practice Address - Phone:215-245-1818
Practice Address - Fax:215-245-9129
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY105308213ES0103X
PASC007165213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery