Active NPI
Mohammad Mahboob, M.D.
- Neuropathology Physician
- Providence, RI
National Provider Identifier
1194018259
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neuropathology Physician
- License
- LP02281
- Practice address
- 593 Eddy St
Providence, RI 02903-4923 - Phone
- (401) 444-8524
- Fax
- (401) 444-5814
- NPI assigned
- May 24, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | D88974 | MD | |
| Neuropathology Physician | 207ZN0500X | LP02281 | RI | Primary |
Addresses
Primary practice location
593 Eddy St
Providence, RI 02903-4923
Mailing address
593 Eddy St
Providence, RI 02903-4923
Phone (401) 444-8524
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP02281 | RI | MD | Neuropathology Physician |
| D88974 | MD | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1306195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584662400000",
"number": "1194018259",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "593 EDDY ST",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029034923",
"telephone_number": "401-444-8524",
"fax_number": "401-444-5814"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "593 EDDY ST",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029034923",
"telephone_number": "401-444-8524",
"fax_number": "401-444-5814"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAHBOOB",
"first_name": "MOHAMMAD",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-05-24",
"last_updated": "2020-03-20",
"certification_date": "2020-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "MD",
"license": "D88974",
"primary": false
},
{
"code": "207ZN0500X",
"taxonomy_group": "",
"desc": "Pathology, Neuropathology",
"state": "RI",
"license": "LP02281",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Providence, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.