Provider Demographics
NPI:1174236467
Name:SAED, MAHMOOD
Entity type:Individual
Prefix:
First Name:MAHMOOD
Middle Name:
Last Name:SAED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3219 COLUMBIA PIKE STE 300A
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-4358
Mailing Address - Country:US
Mailing Address - Phone:240-796-6772
Mailing Address - Fax:
Practice Address - Street 1:5550 COLUMBIA PIKE APT 266
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-5830
Practice Address - Country:US
Practice Address - Phone:202-993-9398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-233100390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA87-2504009Medicaid