Basic Information
| Provider Information | |||||||||
| NPI: | 1376537407 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KANJWAL | ||||||||
| FirstName: | MOHAMMED | ||||||||
| MiddleName: | YOUSEF | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2401 WEST BELVEDERE AVENUE | ||||||||
| Address2: | DEPARTMENT OF CREDENTIALING | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106015524 | ||||||||
| FaxNumber: | 4106018946 | ||||||||
| Practice Location | |||||||||
| Address1: | 5051 GREENSPRING AVENUE | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106019355 | ||||||||
| FaxNumber: | 4106018704 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2005 | ||||||||
| LastUpdateDate: | 12/16/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 35078130 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 2195557 | 05 | OH | MEDICAID |