Provider Demographics
NPI:1689749871
Name:MAHGOUB, MOHAMED ABDELKAWY EZZAT (MD)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:ABDELKAWY EZZAT
Last Name:MAHGOUB
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 1:8 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3925
Mailing Address - Country:US
Mailing Address - Phone:603-577-2045
Mailing Address - Fax:603-577-5644
Practice Address - Street 1:8 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3925
Practice Address - Country:US
Practice Address - Phone:603-577-2045
Practice Address - Fax:603-577-5644
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12748207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30205331Medicaid
NH138818Medicare UPIN
NH30205331Medicaid