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General NPI Number Information
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NPI Number | 1568503191
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Entity Type | Individual
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Provider Name | MAHSA MOGHADDAM SMOOT MBBS
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Gender | Female
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | 1650 4TH ST SE
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City | ROCHESTER
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State | MN
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Zip | 55904-4717
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Country | US
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Telephone | 507-529-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 1650 4TH ST SE
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City | ROCHESTER
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State | MN
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Zip | 55904-4717
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Country | US
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Telephone | 507-529-6600
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 49671
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 49671
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 49671
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License Number State | MN
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