Basic Information
| Provider Information | |||||||||
| NPI: | 1215139274 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOSSA-BASHA | ||||||||
| FirstName: | MAHMUD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 50095 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981455095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065436420 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 MANNING DR | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275144220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9849741000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2007 | ||||||||
| LastUpdateDate: | 04/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0700X | MD60281860 | WA | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0700X | D71238 | MD | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085R0202X | 4301086401 | MI | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085D0003X | 2022-00219 | NC | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Neuroimaging |
ID Information
| ID | Type | State | Issuer | Description | 1215139274 | 05 | WA | MEDICAID |