Provider Demographics
NPI:1487604971
Name:MAROOF, MOHAMMAD (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:
Last Name:MAROOF
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 1:3917 CITY OF OAKS WYND
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5308
Mailing Address - Country:US
Mailing Address - Phone:919-788-8827
Mailing Address - Fax:866-347-8377
Practice Address - Street 1:4041 ED DR
Practice Address - Street 2:SUITE 104 & 108
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8004
Practice Address - Country:US
Practice Address - Phone:919-783-8377
Practice Address - Fax:866-347-8377
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22655207L00000X, 2084P2900X, 207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
No207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891026UMedicaid
NC891026UMedicaid
NC2235677AMedicare ID - Type Unspecified