Healthcare Provider Details

I. General information

NPI: 1962933655
Provider Name (Legal Business Name): MOHAMMEDMOIZ QURESHI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PAGE ST
NEW BEDFORD MA
02740-3464
US

IV. Provider business mailing address

731 KRAFFEL LN
CHESTERFIELD MO
63017-8060
US

V. Phone/Fax

Practice location:
  • Phone: 508-997-1515
  • Fax:
Mailing address:
  • Phone: 615-617-9795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number282177
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number04-52603
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number04-52603
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2020028414
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberT2957
License Number StateTX
# 7
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number282177
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: