Provider Demographics
NPI:1326731225
Name:HUSSEINZADEH, SOROSH (MD)
Entity Type:Individual
Prefix:
First Name:SOROSH
Middle Name:
Last Name:HUSSEINZADEH
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 1:1301 MEDICAL CENTER DRIVE, 4605 TVC
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-5310
Mailing Address - Country:US
Mailing Address - Phone:615-343-4882
Mailing Address - Fax:615-343-7023
Practice Address - Street 1:1301 MEDICAL CENTER DRIVE, 4605 TVC
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-5310
Practice Address - Country:US
Practice Address - Phone:615-343-4882
Practice Address - Fax:615-343-7023
Is Sole Proprietor?:No
Enumeration Date:2023-05-29
Last Update Date:2023-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program