Provider Demographics
NPI:1174510002
Name:GOLPARIAN, MOHAMMAD (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
Last Name:GOLPARIAN
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 1:3769 CROSSINGS DR STE B
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7270
Mailing Address - Country:US
Mailing Address - Phone:928-888-9750
Mailing Address - Fax:928-888-9790
Practice Address - Street 1:3769 CROSSINGS DR STE B
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7270
Practice Address - Country:US
Practice Address - Phone:480-808-8281
Practice Address - Fax:330-624-9294
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32921208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ880733OtherAHCCCS
AZZ179876Medicare PIN
Z82574Medicare PIN
AZ880733OtherAHCCCS