Provider Demographics
NPI:1477542306
Name:MOSTAAN, MEHRDAD (MD)
Entity Type:Individual
Prefix:
First Name:MEHRDAD
Middle Name:
Last Name:MOSTAAN
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:PO BOX 61443
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20859-1443
Mailing Address - Country:US
Mailing Address - Phone:301-983-8237
Mailing Address - Fax:301-983-3935
Practice Address - Street 1:7525 GREENWAY CENTER DR STE T3
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3527
Practice Address - Country:US
Practice Address - Phone:301-983-8237
Practice Address - Fax:301-983-3935
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD24061207RC0000X, 207RI0011X
PAMD420656207RI0011X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA022106OtherTRIGON BC/BS
MD041618OtherAETNA US HEALTHCARE
MD6256MOtherBC/BS MARYLAND
MD2118989OtherALLIANCE, MDIPA, OPTIMUM
MD25803OtherMD IPA
MD32665Medicaid
MD326651600Medicaid
MDC88937Medicare UPIN