Individual provider Active NPI

Mahmoud Gouda Abdelrahman Abdelsalam

  • Student in an Organized Health Care Education/Training Program
  • Houston, TX
National Provider Identifier
1053970640
Registry record updated Apr 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
6550 Fannin St Ste 1801
Houston, TX 77030-2744
Phone
(346) 238-0115
NPI assigned
Jun 7, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

6550 Fannin St Ste 1801
Houston, TX 77030-2744

Mailing address

3100 Maccorkle Ave SE Ste 101
Charleston, WV 25304-1215
Phone (304) 388-8200

Other practice location 1

3100 MacCorkle Ave SE Ste 101
Charleston, WV 25304-1215
Phone (304) 388-8200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190806001210 PA Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 5597092148

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1559865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744675200000",
    "number": "1053970640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 MACCORKLE AVE SE STE 101",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041215",
            "telephone_number": "304-388-8200",
            "fax_number": "304-388-7087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6550 FANNIN ST STE 1801",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770302744",
            "telephone_number": "346-238-0115"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3100 MacCorkle Ave SE Ste 101",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "WV",
            "postal_code": "253041215",
            "country_code": "US",
            "telephone_number": "304-388-8200",
            "fax_number": "304-388-7087",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ABDELSALAM",
        "first_name": "MAHMOUD",
        "middle_name": "GOUDA ABDELRAHMAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-07",
        "last_updated": "2025-04-15",
        "certification_date": "2025-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.