Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0210X | Pediatric Nephrologist | 176291-1205 | UT |
Y | 2080P0210X | Pediatric Nephrologist | 25MA07629100 | NJ |
NPI | 1043594120 |
---|---|
Provider Name | Dr. Mahmoud Loghman-Adham |
First Address | Nutley, NJ 07110-1150 |
Second Address | Nutley, NJ 07110-1150 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2011 |
Last Update Date | 06/10/2011 |