Provider Demographics
NPI:1982655965
Name:MEHDI, MOHAMMAD (MD)
Entity Type:Individual
Prefix:PROF
First Name:MOHAMMAD
Middle Name:
Last Name:MEHDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MOHAMMAD
Other - Middle Name:
Other - Last Name:MEHDI
Other - Suffix:IV
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 398
Mailing Address - Street 2:
Mailing Address - City:NASSAU
Mailing Address - State:DE
Mailing Address - Zip Code:19969-0398
Mailing Address - Country:US
Mailing Address - Phone:302-644-2160
Mailing Address - Fax:
Practice Address - Street 1:17274 COASTAL HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-6210
Practice Address - Country:US
Practice Address - Phone:302-644-2160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10006023207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEH32192Medicare UPIN
DEG01841Medicare ID - Type Unspecified