Provider Demographics
NPI:1538155080
Name:KHAMIEES, MOHAMMAD D (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:D
Last Name:KHAMIEES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3353 MENDON RD STE 3
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-2122
Mailing Address - Country:US
Mailing Address - Phone:401-405-0899
Mailing Address - Fax:401-405-0890
Practice Address - Street 1:3353 MENDON RD STE 3
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864
Practice Address - Country:US
Practice Address - Phone:401-405-0899
Practice Address - Fax:401-405-0890
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD12201207RC0200X, 207RS0012X, 207RP1001X
MA217721207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
467852OtherTUFTS
MAJ28133OtherBCBS
MA110039398AMedicaid
RI32061OtherNEIGHBORHOOD HEALTH PLAN
RI32421-0OtherBLUE SHIELD
AA103431OtherHARVARD PILGRIM
RI7058840Medicaid
RI413696OtherBLUE CHIP
AA103431OtherHARVARD PILGRIM
RI32421-0OtherBLUE SHIELD
RI7058840Medicaid