Provider Demographics
NPI:1871764241
Name:MAMSA, ABDUL R H (MD)
Entity type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:R H
Last Name:MAMSA
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 1:820 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-6625
Mailing Address - Country:US
Mailing Address - Phone:407-847-9100
Mailing Address - Fax:407-847-4412
Practice Address - Street 1:820 W OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-6625
Practice Address - Country:US
Practice Address - Phone:407-847-9100
Practice Address - Fax:407-847-4412
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00515852084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049533600Medicaid
FL049533600Medicaid