Provider Demographics
NPI:1114443082
Name:MOSALLAIE, SEYED ALI (MD)
Entity Type:Individual
Prefix:
First Name:SEYED ALI
Middle Name:
Last Name:MOSALLAIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SEYED ALI AGHA
Other - Middle Name:
Other - Last Name:MOSALLAIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:410-955-6615
Mailing Address - Fax:
Practice Address - Street 1:601 N CAROLINE ST # 3245
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0006
Practice Address - Country:US
Practice Address - Phone:410-955-6615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT2209852085N0700X
MDD00948142085N0904X
DCMD2100120332085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology