Provider Demographics
NPI:1154340842
Name:MAHMOOD, SHAHID (MD)
Entity type:Individual
Prefix:
First Name:SHAHID
Middle Name:
Last Name:MAHMOOD
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 1:11 ELLINGTON PL
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-2014
Mailing Address - Country:US
Mailing Address - Phone:201-951-7233
Mailing Address - Fax:201-816-9431
Practice Address - Street 1:46 JACKSON DR
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-3504
Practice Address - Country:US
Practice Address - Phone:908-272-0699
Practice Address - Fax:908-272-1478
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05915400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2747293000OtherAMERIHEALTH #
NJ100070OtherAMERIGROUP #
NJ7803401Medicaid
NJ7803401Medicaid
NJ2747293000OtherAMERIHEALTH #