1700045267 NPI number — E P MOSHEDI MD PA

Table of content: (NPI 1700045267)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700045267 NPI number — E P MOSHEDI MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
E P MOSHEDI MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700045267
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 630539
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21263-0539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-552-5000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9841 GREENBELT RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
LANHAM
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20706-6269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-552-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MOSHEDI
Authorized Official First Name:
EMIL
Authorized Official Middle Name:
PAYMAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-552-5000

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  D0042747 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 593010300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3530 0001 . This is a "CAREFIRST BLUECROSS BLUESHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1023658 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 180031454 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 255643 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 88630 . This is a "AMERIGROUP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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