Provider Demographics
NPI:1396728697
Name:MAHMOOD, UMAR (MD PHD)
Entity type:Individual
Prefix:DR
First Name:UMAR
Middle Name:
Last Name:MAHMOOD
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-6477
Mailing Address - Fax:617-726-6165
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:FND 2 RADIOLOGICAL ASSOCIATES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-726-5788
Practice Address - Fax:617-726-5708
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2012-08-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2081812085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0134091Medicaid
MA208181OtherTUFTS HEALTH PLAN
MAJ23230OtherBCBS MA
H36318Medicare UPIN
MAJ23230OtherBCBS MA