Provider Demographics
NPI:1588741904
Name:MANNAN, MOHAMMAD Y (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:Y
Last Name:MANNAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1709 KY ROUTE 321
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-9097
Mailing Address - Country:US
Mailing Address - Phone:606-886-8546
Mailing Address - Fax:606-886-8548
Practice Address - Street 1:940 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:SALYERSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41465-9251
Practice Address - Country:US
Practice Address - Phone:606-298-3412
Practice Address - Fax:606-298-5123
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2024-09-19
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Provider Licenses
StateLicense IDTaxonomies
KY38017207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64082548Medicaid
KYP00197698OtherRAILROAD MEDICARE
KY000001215568OtherCHA PROVIDER ID
KY000000334095OtherBLUE CROSS BLUE SHIELD
KY0933601OtherMEDICARE NATIONAL GOVERNMENT SERVICES
KY000000334095OtherBLUE CROSS BLUE SHIELD