Provider Demographics
NPI:1982700787
Name:MUMTAZ B. MEHOOB
Entity Type:Organization
Organization Name:MUMTAZ B. MEHOOB
Other - Org Name:40 WEST WALK IN MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUMTAZ
Authorized Official - Middle Name:BANU
Authorized Official - Last Name:MEHBOOB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-465-6300
Mailing Address - Street 1:8455 BALTIMORE NATIONAL PIKE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4208
Mailing Address - Country:US
Mailing Address - Phone:410-465-6300
Mailing Address - Fax:410-465-1943
Practice Address - Street 1:8455 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:SUITE C
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4208
Practice Address - Country:US
Practice Address - Phone:410-465-6300
Practice Address - Fax:410-465-1943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center