1932643970 NPI number — MAHSA MOSSADEGH MD PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932643970 NPI number — MAHSA MOSSADEGH MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAHSA MOSSADEGH MD PLLC
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:
6
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:
1932643970
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9200 PINECROFT DR
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
SHENANDOAH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77380-3279
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-296-7377
Provider Business Mailing Address Fax Number:
281-296-7255

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9200 PINECROFT DR
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
SHENANDOAH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77380-3279
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-296-7377
Provider Business Practice Location Address Fax Number:
281-296-7255
Provider Enumeration Date:
12/09/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MOSSADEGH
Authorized Official First Name:
MAHSA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
281-296-7377

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  L7059 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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