Provider Demographics
NPI:1144233636
Name:MOBASSERI, KEYHAN (MD)
Entity Type:Individual
Prefix:MRS
First Name:KEYHAN
Middle Name:
Last Name:MOBASSERI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KEYHAN
Other - Middle Name:
Other - Last Name:MARVDASHTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7211 BROADWAY AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-1400
Mailing Address - Country:US
Mailing Address - Phone:216-441-5474
Mailing Address - Fax:216-441-3865
Practice Address - Street 1:7211 BROADWAY AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-1400
Practice Address - Country:US
Practice Address - Phone:216-441-5474
Practice Address - Fax:216-441-3865
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35035275M207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0419591OtherMEDICARE PICAN
OH0215172Medicaid
OHA75520Medicare UPIN