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NPI Code Detail

MEDICARE: MATEEN COLLIS MOGHBEL MD

MEDICARE: MATEEN COLLIS MOGHBEL 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
12085R0202XDiagnostic Radiology Physician285940MA
22085N0904XNuclear Radiology PhysicianD0105128MD

General Provider Information

NPI Number : 1760986905
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATEEN COLLIS MOGHBEL MD
Provider Business Mailing Address
First Line : 331 OAK MANOR DR STE 102
Second Line :
City : GLEN BURNIE
State : MD
Zip : 21061-5553
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 331 OAK MANOR DR STE 102
Second Line :
City : GLEN BURNIE
State : MD
Zip : 21061-5553
Country : US
Telephone Number : 443-333-1894
Fax Number : 443-333-1894
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2018
Last Update Date : 12/09/2025

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