Provider Demographics
NPI:1679593875
Name:ALAM, MAHMOOD (MD)
Entity type:Individual
Prefix:DR
First Name:MAHMOOD
Middle Name:
Last Name:ALAM
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 1:616 AMBOY AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-3164
Mailing Address - Country:US
Mailing Address - Phone:732-636-6262
Mailing Address - Fax:732-636-8313
Practice Address - Street 1:616 AMBOY AVE
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-3164
Practice Address - Country:US
Practice Address - Phone:732-636-6262
Practice Address - Fax:732-636-8313
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05745800207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8648808Medicaid
NJ051768Medicare ID - Type Unspecified
NJ8648808Medicaid