Provider Demographics
NPI:1093013781
Name:MORTEZAVI, MAHTA (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHTA
Middle Name:
Last Name:MORTEZAVI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 ALEXANDER ST
Mailing Address - Street 2:STE 3000
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-4047
Mailing Address - Country:US
Mailing Address - Phone:585-922-8350
Mailing Address - Fax:
Practice Address - Street 1:222 ALEXANDER ST STE 3000
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-4047
Practice Address - Country:US
Practice Address - Phone:585-922-8350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282225207RR0500X, 207RA0201X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology