Provider Demographics
NPI:1225146947
Name:MOHTASHAM, FARZANA (MD)
Entity Type:Individual
Prefix:MRS
First Name:FARZANA
Middle Name:
Last Name:MOHTASHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MRS
Other - First Name:FARZANA
Other - Middle Name:MOHTASHAM
Other - Last Name:MASSIMI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6330 N CENTER DR
Mailing Address - Street 2:BLDG 13 SUITE 220
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4008
Mailing Address - Country:US
Mailing Address - Phone:757-466-0089
Mailing Address - Fax:757-466-8017
Practice Address - Street 1:6330 N CENTER DR
Practice Address - Street 2:BLDG 13 SUITE 220
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4008
Practice Address - Country:US
Practice Address - Phone:757-466-0089
Practice Address - Fax:757-466-8017
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058524207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G97577Medicare UPIN