Provider Demographics
NPI:1386721579
Name:MOHAMED, MOHAMED G (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:G
Last Name:MOHAMED
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 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:
Practice Address - Street 1:1914 STATE ROAD 44
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-8345
Practice Address - Country:US
Practice Address - Phone:386-428-3241
Practice Address - Fax:844-295-1379
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD430130207Q00000X
FLME116369207QG0300X
NY252170207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03080848Medicaid
FLME116369OtherMEDICAL LICENSE
FLFM0009375OtherDEA CERTIFICATE
NYJ400002927Medicare PIN
NY03080848Medicaid