Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 39319 | KY |
NPI | 1174527956 |
---|---|
Provider Name | Sanaa Abdel-Rahman Mahmoud |
First Address | Somerset, KY 42503-3818 |
Second Address | Somerset, KY 42503-3818 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 03/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I 25972 | (02) | KY |