Basic Information
| Provider Information | |||||||||
| NPI: | 1982694642 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAHMOUD | ||||||||
| FirstName: | AKRAM | ||||||||
| MiddleName: | H | ||||||||
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| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 905 HANSHAW RD STE A | ||||||||
| Address2: | |||||||||
| City: | ITHACA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 148501549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6072690033 | ||||||||
| FaxNumber: | 6072690037 | ||||||||
| Practice Location | |||||||||
| Address1: | 905 HANSHAW RD STE A | ||||||||
| Address2: | |||||||||
| City: | ITHACA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 148501549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6072690033 | ||||||||
| FaxNumber: | 6072690037 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2005 | ||||||||
| LastUpdateDate: | 08/05/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 2018-00346 | NC | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 63470-21 | WI | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 305839 | NY | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2380570 | 05 | OH | MEDICAID |