Provider Demographics
NPI:1548248297
Name:RAHMAN, MAHMOOD (MD)
Entity type:Individual
Prefix:
First Name:MAHMOOD
Middle Name:
Last Name:RAHMAN
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 1:76 FORDWAY DR.
Mailing Address - Street 2:STE 2
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377
Mailing Address - Country:US
Mailing Address - Phone:937-890-3139
Mailing Address - Fax:937-890-3111
Practice Address - Street 1:76 FORDWAY DR.
Practice Address - Street 2:STE 2
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377
Practice Address - Country:US
Practice Address - Phone:937-890-3139
Practice Address - Fax:937-890-3111
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35066692R2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0976949Medicaid
OHRA0764598Medicare PIN
OHRA0764597Medicare PIN
F63087Medicare UPIN