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General NPI Number Information
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NPI Number | 1114443082
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Entity Type | Individual
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Provider Name | SEYED ALI MOSALLAIE MD
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Gender | Male
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Dates
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Enumeration Date | 08/22/2017
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Last Update Date | 07/13/2023
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Provider Practice Location Address
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Address Line | 601 N CAROLINE ST # 3245
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City | BALTIMORE
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State | MD
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Zip | 21287-0006
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Country | US
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Telephone | 410-955-6615
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Fax |
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Provider Business Mailing Address
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Address Line | 6201 GREENLEIGH AVE
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City | MIDDLE RIVER
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State | MD
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Zip | 21220-2004
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Country | US
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Telephone | 410-955-6615
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | MT220985
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2085N0904X
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Taxonomy Name | Nuclear Radiology Physician
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License Number | D0094814
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 2085N0904X
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Taxonomy Name | Nuclear Radiology Physician
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License Number | MD210012033
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License Number State | DC
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