Provider Demographics
NPI:1548420417
Name:ATA O MOSHYEDI MD PA
Entity Type:Organization
Organization Name:ATA O MOSHYEDI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ATA
Authorized Official - Middle Name:O
Authorized Official - Last Name:MOSHYEDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-805-4586
Mailing Address - Street 1:7305 HANOVER PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2030
Mailing Address - Country:US
Mailing Address - Phone:301-982-7900
Mailing Address - Fax:
Practice Address - Street 1:7305 HANOVER PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2030
Practice Address - Country:US
Practice Address - Phone:301-982-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0046093207RG0100X
MDD0009179207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD112507442OtherRAILROAD MEDICARE
MD4054276OtherAETNA
MD4768 0002OtherCAREFIRST BLUE CROSS BLUE SHIELD
MD4566293OtherAETNA
MD72489OtherAMERIGROUP
MD017961200Medicaid
MD4768 0001OtherCAREFIRST BLUE CROSS BLUE SHIELD
MD110083708OtherRAILROAD MEDICARE
MD6239AOOtherBLUE SHIELD OF MARYLAND
MD4768 0002OtherCAREFIRST BLUE CROSS BLUE SHIELD
MD4054276OtherAETNA