Healthcare Provider Details

I. General information

NPI: 1073445474
Provider Name (Legal Business Name): SOMAYEH MOHAMMADI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

637 E WOODLAND PARK AVE
CHICAGO IL
60616-4159
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-1239
  • Fax:
Mailing address:
  • Phone: 617-230-6473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberNA
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: