Provider Demographics
NPI:1235118381
Name:MOGHBELI, HOMAYOON (MD)
Entity Type:Individual
Prefix:DR
First Name:HOMAYOON
Middle Name:
Last Name:MOGHBELI
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 1:8725 LOCH RAVEN BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-2207
Mailing Address - Country:US
Mailing Address - Phone:410-882-3459
Mailing Address - Fax:410-882-1490
Practice Address - Street 1:1421 S CATON AVE STE 101
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-1029
Practice Address - Country:US
Practice Address - Phone:410-646-5055
Practice Address - Fax:410-646-5058
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD17720174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB67120Medicare UPIN
MDKN80Medicare PIN