Healthcare Provider Details

I. General information

NPI: 1356542187
Provider Name (Legal Business Name): MOHAMMAD NOURMOHAMMADI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 TER HEUN DR
FALMOUTH MA
02540-2503
US

IV. Provider business mailing address

100 TER HEUN DR
FALMOUTH MA
02540-2503
US

V. Phone/Fax

Practice location:
  • Phone: 508-457-5690
  • Fax:
Mailing address:
  • Phone: 508-457-5690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number261661
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA117967
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: