MEDICARE: DR. MAHRAD PAYMANI M.D.

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	2085R0202X	Diagnostic Radiology Physician	ME78823	FL
2	2085R0204X	Vascular & Interventional Radiology Physician	ME78823	FL
3	202K00000X	Phlebology Physician	ME78823	FL
4	207RM1200X	Magnetic Resonance Imaging (MRI) Internal Medicine Physician	78823	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	300107920	OTHER	FL	RR MEDICARE LMIV
3	300114871	OTHER	FL	RR MEDICARE RACF

Other Identifiers

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

General Provider Information

NPI Number	:	1447218201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAHRAD PAYMANI M.D.

Provider Business Mailing Address
First Line	:	734 N 3RD ST
Second Line	:	SUITE 115
City	:	LEESBURG
State	:	FL
Zip	:	34748-5285
Country	:	US
Telephone Number	:	352-365-2583
Fax Number	:	352-728-6749

Provider Business Practice Location Address
First Line	:	801 E DIXIE AVE
Second Line	:	SUITE 104
City	:	LEESBURG
State	:	FL
Zip	:	34748-7601
Country	:	US
Telephone Number	:	352-365-2583
Fax Number	:	352-728-6749

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

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	02/24/2016

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Directions to “ DR. MAHRAD PAYMANI M.D.” Practice Location

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