Provider Demographics
NPI:1083154389
Name:ATAEI, MANOUCHEHR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MANOUCHEHR
Middle Name:
Last Name:ATAEI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 GEIPE ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228
Mailing Address - Country:US
Mailing Address - Phone:410-744-0661
Mailing Address - Fax:410-744-8036
Practice Address - Street 1:700 GEIPE ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228
Practice Address - Country:US
Practice Address - Phone:410-744-0661
Practice Address - Fax:410-744-8036
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0006284363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant