Provider Demographics
NPI:1205278843
Name:ABDULMAHDI, MUSTAFA (MD)
Entity type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:
Last Name:ABDULMAHDI
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 1:900 CATON AVE
Mailing Address - Street 2:MAILBOX 198
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5201
Mailing Address - Country:US
Mailing Address - Phone:410-368-8858
Mailing Address - Fax:410-368-3525
Practice Address - Street 1:900 CATON AVE
Practice Address - Street 2:MAILBOX 198
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5201
Practice Address - Country:US
Practice Address - Phone:410-368-8858
Practice Address - Fax:410-368-3525
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2018-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD83865207RC0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty