Provider Demographics
NPI:1023293826
Name:MOHIUDDIN, MOHAMMED M (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:M
Last Name:MOHIUDDIN
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 1:801 TOLL HOUSE
Mailing Address - Street 2:BUILDING B2
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701
Mailing Address - Country:US
Mailing Address - Phone:301-694-8080
Mailing Address - Fax:301-694-8089
Practice Address - Street 1:801 TOLL HOUSE AVE
Practice Address - Street 2:BLDG B2
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701
Practice Address - Country:US
Practice Address - Phone:301-694-8080
Practice Address - Fax:301-694-8089
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0020015208800000X
WV10996208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3003208000Medicaid
WV3003208000Medicaid
WV4092041Medicare UPIN