Healthcare Provider Details

I. General information

NPI: 1457537433
Provider Name (Legal Business Name): NAVID MAHOOTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 ENDICOTT ST SUITE 104
DANVERS MA
01923-3623
US

IV. Provider business mailing address

104 ENDICOTT ST SUITE 104
DANVERS MA
01923-3623
US

V. Phone/Fax

Practice location:
  • Phone: 978-882-6700
  • Fax: 978-646-8553
Mailing address:
  • Phone: 978-882-6700
  • Fax: 978-646-8553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number245956
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: