Provider Demographics
NPI:1083403935
Name:MAHMOOD, KHURRAM
Entity type:Individual
Prefix:
First Name:KHURRAM
Middle Name:
Last Name:MAHMOOD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 COTTONWOOD LN APT B
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-4714
Mailing Address - Country:US
Mailing Address - Phone:929-290-7541
Mailing Address - Fax:
Practice Address - Street 1:9 COTTONWOOD LN APT B
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-4714
Practice Address - Country:US
Practice Address - Phone:929-290-7541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies