Provider Demographics
NPI:1528088325
Name:MOHAMED, ABDELRAHMAN H (MD)
Entity type:Individual
Prefix:
First Name:ABDELRAHMAN
Middle Name:H
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 1:1907 W. MORRIS BLVD.
Mailing Address - Street 2:SUITE A400
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813
Mailing Address - Country:US
Mailing Address - Phone:423-587-7144
Mailing Address - Fax:423-587-7145
Practice Address - Street 1:1907 W. MORRIS BLVD.
Practice Address - Street 2:SUITE A400
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813
Practice Address - Country:US
Practice Address - Phone:423-587-7144
Practice Address - Fax:423-587-7145
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN203274325174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3853013Medicaid
TNH16107Medicare UPIN
TN3853013Medicaid