Provider Demographics
NPI:1871137620
Name:MAHMOOD, AISHA
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:
Last Name:MAHMOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8851 DELEGGE RD
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-2067
Mailing Address - Country:US
Mailing Address - Phone:248-469-2014
Mailing Address - Fax:
Practice Address - Street 1:8125 PULASKI HWY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-2843
Practice Address - Country:US
Practice Address - Phone:410-999-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD171371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice