Provider Demographics
NPI:1902841927
Name:MUMTAZ, MUHAMMAD A (MD)
Entity type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:A
Last Name:MUMTAZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:MUHAMMAD
Other - Middle Name:ATHAR
Other - Last Name:MUMTAZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:BMCHS PROVIDER ENROLLMENT
Mailing Address - Street 2:960 MASSACHUSETTS AVE FLR 2
Mailing Address - City:BOS
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:GSMC - HOSPITALISTS
Practice Address - Street 2:235 NORTH PEARL ST
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4012
Practice Address - Country:US
Practice Address - Phone:508-427-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA35780OtherHEALTHY START
MAJ23605OtherBLUE CROSS BLUE SHIELD
0025950OtherNEIGHBORHOOD HEALTH PLAN
MA35780OtherHEALTHY START
MAJ23605OtherBLUE CROSS BLUE SHIELD