Healthcare Provider Details

I. General information

NPI: 1083811616
Provider Name (Legal Business Name): SAM MOGHTADERI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 12/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 M ST NW 5TH FLOOR
WASHINGTON DC
20037-1434
US

IV. Provider business mailing address

2300 M ST NW 5TH FLOOR
WASHINGTON DC
20037-1434
US

V. Phone/Fax

Practice location:
  • Phone: 202-741-3311
  • Fax: 202-741-3313
Mailing address:
  • Phone: 202-741-3311
  • Fax: 202-741-3313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number247012
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number043702
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: