MEDICARE: FATEMEH RHANA MOUSAVI 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	207ZP0101X	Anatomic Pathology Physician	ME94764	FL
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	ME94764	FL
3	207ZC0500X	Cytopathology Physician	ME94764	FL

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

General Provider Information

NPI Number	:	1417159682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FATEMEH RHANA MOUSAVI MD

Provider Business Mailing Address
First Line	:	10425 AVENIDA DEL RIO
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-2417
Country	:	US
Telephone Number	:	561-306-4906
Fax Number	:	561-270-0391

Provider Business Practice Location Address
First Line	:	5361 NW 33RD AVE
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-6313
Country	:	US
Telephone Number	:	954-717-0300
Fax Number	:	561-270-0391

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

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	06/30/2021

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