Provider Demographics
NPI:1730153701
Name:MAHMOOD, HASSAN (MD)
Entity type:Individual
Prefix:
First Name:HASSAN
Middle Name:
Last Name:MAHMOOD
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7818
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:378 THOMPSON POYNTER RD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-7238
Practice Address - Country:US
Practice Address - Phone:606-877-3990
Practice Address - Fax:606-877-3993
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38665208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50005620OtherPASSPORT HEALTH PLAN
KY000000377918OtherANTHEM
KY61-1427889OtherHUMANA
KY61-1427889OtherTRICARE
KY61-1427889OtherBLUEGRASS FAMILY HEALTH
KY61-1427889OtherUHC
KYC12870OtherCUMBERLAND HEALTHCARE INC
KY61-1427889OtherCHA
KY64080773Medicaid
KY030670000OtherBLACK LUNG