Healthcare Provider Details

I. General information

NPI: 1548258346
Provider Name (Legal Business Name): MOHAMMED ALI VASEF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS NE
ALBUQUERQUE NM
87131
US

IV. Provider business mailing address

1650 UNIVERSITY NE SUITE 116
ALBUQUERQUE NM
87102
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4814
  • Fax: 505-272-8084
Mailing address:
  • Phone: 505-272-4814
  • Fax: 505-272-8084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberMD20050718
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number29565
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD20050718
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberA53441
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number29565
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: