Provider Demographics
NPI:1699764688
Name:MOHAMED, MAHMOUD ABDELMONEM (MD)
Entity type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:ABDELMONEM
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 1:460 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MADAWASKA
Mailing Address - State:ME
Mailing Address - Zip Code:04756-1014
Mailing Address - Country:US
Mailing Address - Phone:207-728-7300
Mailing Address - Fax:207-728-7838
Practice Address - Street 1:1200 EAST BRIN STREET
Practice Address - Street 2:TERRELL STATE HOSPITAL
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160
Practice Address - Country:US
Practice Address - Phone:972-551-8166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0168492084P0800X
TXN58752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB156690Medicare PIN
ME1489Medicare ID - Type Unspecified