Provider Demographics
NPI:1467794297
Name:HAJGHASSEMALI, MEHRDOKHT (MD)
Entity Type:Individual
Prefix:
First Name:MEHRDOKHT
Middle Name:
Last Name:HAJGHASSEMALI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38139-6706
Mailing Address - Country:US
Mailing Address - Phone:901-757-8222
Mailing Address - Fax:
Practice Address - Street 1:2404 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38139-6706
Practice Address - Country:US
Practice Address - Phone:901-757-8222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD009530207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3179055Medicare Oscar/Certification