Provider Demographics
NPI:1699769257
Name:MAH'MOUD, MITCHELL AMUDA (MD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:AMUDA
Last Name:MAH'MOUD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 18563
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27619-8563
Mailing Address - Country:US
Mailing Address - Phone:919-782-1806
Mailing Address - Fax:919-782-4756
Practice Address - Street 1:540 NORTH ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4016
Practice Address - Country:US
Practice Address - Phone:919-341-3621
Practice Address - Fax:919-359-6290
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9700651207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC100014117OtherRAILROAD MEDICARE
NC99185OtherMEDCOST
NC1699769257Medicaid
NC1098EOtherBCBSNC
NC6105788OtherCIGNA HEALTHCARE
NC891098EMedicaid
NC1098EOtherBCBSNC