Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mohammad Islam

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1003268095

Mohammad Islam is a Pulmonary Disease in Newark, Ohio. Qualified in 2011, 15 years ago. Practices with Licking Memorial Professional Corporation, a 235-clinician group and accepts Medicare assignment. Licensed in Ohio.

Years since qualifying
15
Licensed in
OH
In the registry since
2016
Specialties on file
2
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Practice location Address checks out

1272 W Main St Ste 503
Newark, OH 43055-2058
Phone: (220) 564-1805
Fax: (220) 564-1806
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pulmonary Disease Physician (primary) Taxonomy 207RP1001X · Licence 35.145446 (OH)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1003268095
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedJuly 1, 2016
Last updated in NPPESDecember 9, 2022
Certification dateDecember 9, 2022
Mailing address1320 W Main St, Newark, OH 43055-1822

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPULMONARY DISEASE
Medical schoolOTHER
Graduated 2011 (15 years in practice)
Group practice Licking Memorial Professional Corporation — 235 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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