Mohammed Akhlack Hossain Mazumder, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

43704 Issued in KY

Practice address

92 Pickett LN
Prestonsburg, KY 41653-8569

Phone

(606) 874-0112

Fax

(606) 874-0115

NPI assigned

May 21, 2009

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Appalachian Primary Care LLC

  • Primary Care Nurse Practitioner
  • Prestonsburg, KY
  • NPI 1063992733
  NPD Authorized official
• Medical Imaging Group, LLC

  • Clinical Medical Laboratory
  • Paintsville, KY
  • NPI 1134338874
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1242864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534896000000",
    "number": "1043445927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "742 OLD 114",
            "address_2": "APT # 2",
            "city": "PRESTONSBURG",
            "state": "KY",
            "postal_code": "416538300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "92 PICKETT LN",
            "city": "PRESTONSBURG",
            "state": "KY",
            "postal_code": "416538569",
            "telephone_number": "606-874-0112",
            "fax_number": "606-874-0115"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "156 N Lake Dr",
            "address_purpose": "LOCATION",
            "city": "Prestonsburg",
            "state": "KY",
            "postal_code": "416531270",
            "country_code": "US",
            "telephone_number": "606-886-3996",
            "fax_number": "606-886-6337",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAZUMDER",
        "first_name": "MOHAMMED",
        "middle_name": "AKHLACK HOSSAIN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-21",
        "last_updated": "2018-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MT194879",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01068828A.",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "KY",
            "license": "43704",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "43704",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ricki Maynard
• Somer Maynard
• Johnny Mayo
• Kayla Mays
• Jacob Maze
• Michael McAllister
• Kelly McArthur
• Christine McBroom
• Frank McBroom
• Jesslyn McCandless

• Family Medicine Physician in Prestonsburg, KY
• Providers in Prestonsburg, KY by specialty
• Family Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.