MEDICARE: SEYED ABDOLREZA GHODSI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	20199	WV
2	207T00000X	Neurological Surgery Physician	35.078655	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205803814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEYED ABDOLREZA GHODSI MD

Provider Business Mailing Address
First Line	:	416 COLEGATE DR BLDG 3
Second Line	:
City	:	MARIETTA
State	:	OH
Zip	:	45750-9549
Country	:	US
Telephone Number	:	740-568-4814
Fax Number	:	740-374-3165

Provider Business Practice Location Address
First Line	:	807 FARSON ST STE 136
Second Line	:
City	:	BELPRE
State	:	OH
Zip	:	45714-1068
Country	:	US
Telephone Number	:	740-423-3634
Fax Number	:	740-423-3635

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	04/01/2024

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