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NPI Code Detail

MEDICARE: MANDANA MAHMOODI MD

MEDICARE: MANDANA MAHMOODI 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
1207ZD0900XDermatopathology (Pathology) Physician233840MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2M17162OTHERMABLUE CROSS
3800887OTHERMAHARVARD PILGRIM HEALTH CA

General Provider Information

NPI Number : 1982892121
Entity Type Code : Individual
Provider Name (Legal Business Name) : MANDANA MAHMOODI MD
Provider Business Mailing Address
First Line : PO BOX 840294
Second Line :
City : DALLAS
State : TX
Zip : 75284-0294
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 15 CRAWFORD ST STE 100
Second Line :
City : NEEDHAM
State : MA
Zip : 02494-2618
Country : US
Telephone Number : 617-969-4100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2007
Last Update Date : 03/21/2018

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Directions to “ MANDANA MAHMOODI MD” Practice Location

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