Healthcare Provider Details

I. General information

NPI: 1568983872
Provider Name (Legal Business Name): NEDA REZAEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 11/09/2023
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W RANDOL MILL RD
ARLINGTON TX
76012-2504
US

IV. Provider business mailing address

14275 MIDWAY RD STE 400
ADDISON TX
75001-3661
US

V. Phone/Fax

Practice location:
  • Phone: 817-472-3400
  • Fax:
Mailing address:
  • Phone:
  • Fax: 610-271-4245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number2017021076
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: