Provider Demographics
NPI:1174551352
Name:MAHMOOD, DAWAR (MD)
Entity type:Individual
Prefix:
First Name:DAWAR
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 1:23-22 30TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-3255
Mailing Address - Country:US
Mailing Address - Phone:718-274-6208
Mailing Address - Fax:718-267-1990
Practice Address - Street 1:23-22 30TH AVENUE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-3255
Practice Address - Country:US
Practice Address - Phone:718-274-6208
Practice Address - Fax:718-267-1990
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY134586208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00423198Medicaid
NYB17017Medicare UPIN
NY4989GSMedicare PIN
NYG300041098Medicare PIN