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NPI Code Detail

MEDICARE: SAMAREH MOUSSAVAND MD

MEDICARE: SAMAREH MOUSSAVAND 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
12084P0800XPsychiatry Physician35-083297OH
22084P0804XChild & Adolescent Psychiatry Physician35-083297OH

Other Identifiers

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

General Provider Information

NPI Number : 1851317234
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMAREH MOUSSAVAND MD
Provider Business Mailing Address
First Line : 3605 WARRENSVILLE CENTER RD
Second Line :
City : SHAKER HEIGHTS
State : OH
Zip : 44122-5203
Country : US
Telephone Number : 440-684-5979
Fax Number : 440-684-5952
Provider Business Practice Location Address
First Line : 11100 EUCLID AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44106-1716
Country : US
Telephone Number : 216-844-3881
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2006
Last Update Date : 08/02/2019

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Directions to “ SAMAREH MOUSSAVAND MD” Practice Location

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