Provider Demographics
NPI:1871571406
Name:ASWAD, MOHAMED BASEL (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:BASEL
Last Name:ASWAD
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 1:1020 S 8TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030
Mailing Address - Country:US
Mailing Address - Phone:575-546-3750
Mailing Address - Fax:575-546-2770
Practice Address - Street 1:1020 S 8TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030
Practice Address - Country:US
Practice Address - Phone:575-546-3750
Practice Address - Fax:575-546-2770
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM20030043207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1871571406OtherNPI
NM1396073359OtherGROUP NPI
NM37323351Medicaid
1871571406OtherNPI
85-0527868OtherEIN
NM1396073359OtherGROUP NPI