Provider Demographics
NPI:1467781153
Name:AHMADIAN, MORTEZA SEYED (MD)
Entity Type:Individual
Prefix:
First Name:MORTEZA
Middle Name:SEYED
Last Name:AHMADIAN
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 1:1708 PASTURE BROOK WAY
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2947
Mailing Address - Country:US
Mailing Address - Phone:301-340-6702
Mailing Address - Fax:
Practice Address - Street 1:1708 PASTURE BROOK WAY
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-2947
Practice Address - Country:US
Practice Address - Phone:301-340-6702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0000378172A00000X, 213ER0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No172A00000XOther Service ProvidersDriver