MEDICARE: KATHERINE MAHDAVI PA-C

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	363A00000X	Physician Assistant	C0009180	MD

General Provider Information

NPI Number	:	1972379758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE MAHDAVI PA-C

Provider Business Mailing Address
First Line	:	1306 CONCOURSE DR STE 201
Second Line	:
City	:	LINTHICUM HEIGHTS
State	:	MD
Zip	:	21090-1033
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	180 ADMIRAL COCHRANE DR STE 410
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-8405
Country	:	US
Telephone Number	:	410-263-5439
Fax Number	:

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

Provider Enumeration Date	:	12/01/2023
Last Update Date	:	12/01/2023

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