Provider Demographics
NPI:1588459812
Name:GOUDA, MAZEN MOHAMED (MD)
Entity type:Individual
Prefix:DR
First Name:MAZEN
Middle Name:MOHAMED
Last Name:GOUDA
Suffix:
Gender:
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:WINTER HALL, 735 FAIRFAX AVE., SUITE 1017C
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501
Mailing Address - Country:US
Mailing Address - Phone:757-446-6191
Mailing Address - Fax:
Practice Address - Street 1:825 FAIRFAX AVE STE 206
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-0377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program