MEDICARE: MEHRDAD MARK FERDOWSIAN DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	1019	NV

General Provider Information

NPI Number	:	1265530570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEHRDAD MARK FERDOWSIAN DO

Provider Business Mailing Address
First Line	:	6525 N BUFFALO DR STE 130
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-4041
Country	:	US
Telephone Number	:	702-509-3041
Fax Number	:	702-784-0065

Provider Business Practice Location Address
First Line	:	3175 SAINT ROSE PKWY STE 121
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-3507
Country	:	US
Telephone Number	:	702-802-5100
Fax Number	:	702-202-1066

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	06/02/2025

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