Provider Demographics
NPI:1881707164
Name:RIFFAT S MAHMUD MD PC
Entity type:Organization
Organization Name:RIFFAT S MAHMUD MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RIFFAT
Authorized Official - Middle Name:S
Authorized Official - Last Name:MAHMUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-741-5959
Mailing Address - Street 1:73 E FORREST AVE STE 314
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17361-1400
Mailing Address - Country:US
Mailing Address - Phone:717-235-1795
Mailing Address - Fax:717-428-3417
Practice Address - Street 1:73 E FORREST AVE STE 314
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:PA
Practice Address - Zip Code:17361-1400
Practice Address - Country:US
Practice Address - Phone:717-235-1795
Practice Address - Fax:717-428-3417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053502L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014862170003Medicaid
PA532532VJ9Medicare PIN
PA0014862170003Medicaid
PA080185752Medicare PIN
PADN6880Medicare PIN
PA532532Medicare PIN