Provider Demographics
NPI:1174527956
Name:MAHMOUD, SANAA ABDEL-RAHMAN (MD)
Entity type:Individual
Prefix:
First Name:SANAA
Middle Name:ABDEL-RAHMAN
Last Name:MAHMOUD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HARDIN LN
Mailing Address - Street 2:STE 3
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-3818
Mailing Address - Country:US
Mailing Address - Phone:606-451-0115
Mailing Address - Fax:606-451-0155
Practice Address - Street 1:110 HARDIN LN
Practice Address - Street 2:STE 3
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-3818
Practice Address - Country:US
Practice Address - Phone:606-451-0115
Practice Address - Fax:606-451-0155
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39319207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYI 25972Medicare UPIN
KY0954801Medicare PIN