Provider Demographics
NPI:1124094875
Name:JAWHAR, MAHMOUD O (MD)
Entity type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:O
Last Name:JAWHAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1337
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-1337
Mailing Address - Country:US
Mailing Address - Phone:276-236-3210
Mailing Address - Fax:276-236-8780
Practice Address - Street 1:225 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2228
Practice Address - Country:US
Practice Address - Phone:276-236-6906
Practice Address - Fax:276-236-7179
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-231348208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7306245Medicaid
VA010360609Medicaid
VA007306245Medicaid
VA011769C23Medicare PIN
H41581Medicare UPIN
VA020050248Medicare PIN
VA020001524Medicare PIN
VA005265C47Medicare PIN