Provider Demographics
NPI:1912552696
Name:MAHGOUB, AHMED MOHAMED OSMAN AHMED
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:MOHAMED OSMAN AHMED
Last Name:MAHGOUB
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 TOLL GATE RD
Mailing Address - Street 2:PRC AND CREDENTIALING
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2759
Mailing Address - Country:US
Mailing Address - Phone:401-273-0641
Mailing Address - Fax:401-273-2919
Practice Address - Street 1:1407 S COUNTY TRL STE 430A
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-1679
Practice Address - Country:US
Practice Address - Phone:401-886-7910
Practice Address - Fax:401-886-7913
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICLP04759207R00000X
IL125.080353207RP1001X
390200000X
RIMD20426207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program