Provider Demographics
NPI:1023192713
Name:MOUSAVI, MIR (MD)
Entity Type:Individual
Prefix:
First Name:MIR
Middle Name:
Last Name:MOUSAVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 MIDDLEFORD RD
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-3600
Mailing Address - Country:US
Mailing Address - Phone:302-629-0260
Mailing Address - Fax:302-629-3418
Practice Address - Street 1:701 MIDDLEFORD RD
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-3600
Practice Address - Country:US
Practice Address - Phone:302-629-0260
Practice Address - Fax:302-629-3418
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10001859207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEB66589OtherBCBS DE
DEG254001OtherBCBS DC
DE0000019401OtherDPCI
DE41834801OtherCAREFIRST
DE4275023OtherAETNA
DE0000019401Medicaid
DE0097634000OtherAMERIHEALTH
DE340011OtherMAMSI,ALLIANCE,OPT CHOICE
DE0097634000OtherAMERIHEALTH
DEB66589OtherBCBS DE