Provider Demographics
NPI:1174677587
Name:MOZAYENI, BOBAK ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:BOBAK
Middle Name:ROBERT
Last Name:MOZAYENI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:B.
Other - Middle Name:ROBERT
Other - Last Name:MOZAYENI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6000 EXECUTIVE BLVD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852
Mailing Address - Country:US
Mailing Address - Phone:240-221-0000
Mailing Address - Fax:240-221-0441
Practice Address - Street 1:6000 EXECUTIVE BLVD
Practice Address - Street 2:SUITE #304
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852
Practice Address - Country:US
Practice Address - Phone:240-221-0000
Practice Address - Fax:240-221-0441
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD42423207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE42382Medicare UPIN