Provider Demographics
NPI:1982701611
Name:MAHMOOD, SHAHID (MD,)
Entity type:Individual
Prefix:DR
First Name:SHAHID
Middle Name:
Last Name:MAHMOOD
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 1:1124 OPAL CT
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5940
Mailing Address - Country:US
Mailing Address - Phone:301-733-4496
Mailing Address - Fax:301-733-0963
Practice Address - Street 1:580 NORTHERN AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2847
Practice Address - Country:US
Practice Address - Phone:301-733-4496
Practice Address - Fax:301-733-0963
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063233207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408999500Medicaid
NCG79331Medicare UPIN