Provider Demographics
NPI:1730160938
Name:FUAD, MOHAMMED (PA-C)
Entity type:Individual
Prefix:MR
First Name:MOHAMMED
Middle Name:
Last Name:FUAD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 MDS (AFMC)
Mailing Address - Street 2:90 VANDENBERG DR. BLDG. 1900
Mailing Address - City:HANSCOM AFB
Mailing Address - State:MA
Mailing Address - Zip Code:01731
Mailing Address - Country:US
Mailing Address - Phone:781-225-6789
Mailing Address - Fax:
Practice Address - Street 1:66 MDS (AFMC)
Practice Address - Street 2:90 VANDENBERG DR. BLDG. 1900
Practice Address - City:HANSCOM AFB
Practice Address - State:MA
Practice Address - Zip Code:01731
Practice Address - Country:US
Practice Address - Phone:781-225-6789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12/31/2006363AM0700X
PAMA057703363AM0700X
MAPA5742363AM0700X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical