Provider Demographics
NPI:1962382101
Name:MOHAMMED, KASSIM HAIREDIN (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:KASSIM
Middle Name:HAIREDIN
Last Name:MOHAMMED
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3622 MAVEN ST # A
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-1148
Mailing Address - Country:US
Mailing Address - Phone:202-399-7504
Mailing Address - Fax:
Practice Address - Street 1:5000 NANNIE HELEN BURROUGHS AVE NE # A
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-5506
Practice Address - Country:US
Practice Address - Phone:202-399-7504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1022083163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty