Provider Demographics
NPI:1306994157
Name:MASROOR, MOHAMMAD A (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:A
Last Name:MASROOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5354 REYNOLDS ST STE 505
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6012
Mailing Address - Country:US
Mailing Address - Phone:912-352-1553
Mailing Address - Fax:912-355-3528
Practice Address - Street 1:5354 REYNOLDS ST STE 505
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6012
Practice Address - Country:US
Practice Address - Phone:912-352-1553
Practice Address - Fax:912-355-3528
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA17705207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000087744GMedicaid
GA000087744GMedicaid