Provider Demographics
NPI:1215971262
Name:RAHMAN, MOHAMMED M (MD)
Entity type:Individual
Prefix:MR
First Name:MOHAMMED
Middle Name:M
Last Name:RAHMAN
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 1:4023 74TH ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5603
Mailing Address - Country:US
Mailing Address - Phone:718-424-0200
Mailing Address - Fax:718-424-0866
Practice Address - Street 1:4023 74TH ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5603
Practice Address - Country:US
Practice Address - Phone:718-424-0200
Practice Address - Fax:718-424-0866
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245384207R00000X, 146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64069396Medicaid
KYH86727Medicare UPIN
KY0535533Medicare ID - Type Unspecified