Provider Demographics
NPI:1528014974
Name:DADASH ZADEH, MAHBOUBEH (MD)
Entity Type:Individual
Prefix:
First Name:MAHBOUBEH
Middle Name:
Last Name:DADASH ZADEH
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 1:1109 GREEN ACRE RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-1734
Mailing Address - Country:US
Mailing Address - Phone:410-821-1912
Mailing Address - Fax:
Practice Address - Street 1:1109 GREEN ACRE ROAD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286
Practice Address - Country:US
Practice Address - Phone:410-821-1912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD32153208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB70685OtherUPIN
MDBD1109746OtherDEA
MDB70685OtherUPIN
MDB70685Medicare UPIN
MD152P367GMedicare ID - Type UnspecifiedMCR #