Healthcare Provider Details

I. General information

NPI: 1043667082
Provider Name (Legal Business Name): PARSA HODJAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE., ML 1035
CINCINNATI OH
45229
US

IV. Provider business mailing address

2401 S 31ST ST MS-01-266
TEMPLE TX
76508-0001
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4261
  • Fax: 513-636-3924
Mailing address:
  • Phone: 254-724-7354
  • Fax: 254-724-6329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License Number35.149595
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: