Provider Demographics
NPI:1396799508
Name:MAHMOOD, MOHAMMAD ASIM (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:ASIM
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 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:2 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 205
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3043
Practice Address - Country:US
Practice Address - Phone:916-773-8711
Practice Address - Fax:916-773-8712
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL220092084N0400X
AZ356942084N0400X, 2084V0102X
CAC533122084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00124388Medicaid
FL265595100Medicaid
AL009960880Medicaid
AL009960890Medicaid
AL51507758OtherBLUE CROSS
AL05-00145OtherUNITED HEALTH CARE
AL51504215OtherBLUE CROSS
G77672Medicare UPIN
AL051504215Medicare ID - Type Unspecified
AL05-00145OtherUNITED HEALTH CARE
AZZ113516Medicare PIN