Provider Demographics
NPI:1508823246
Name:MOHSENI, ALEX S (MD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:S
Last Name:MOHSENI
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 11553
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-4553
Mailing Address - Country:US
Mailing Address - Phone:301-725-5652
Mailing Address - Fax:
Practice Address - Street 1:4101 NORTHVIEW DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-2616
Practice Address - Country:US
Practice Address - Phone:301-725-5652
Practice Address - Fax:301-483-3723
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239210207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009679E54Medicare ID - Type Unspecified
I50685Medicare UPIN