Provider Demographics
NPI:1568576924
Name:NEMATI, MASSOUD (MD)
Entity Type:Individual
Prefix:DR
First Name:MASSOUD
Middle Name:
Last Name:NEMATI
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 1:9929 BENTCROSS DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-4741
Mailing Address - Country:US
Mailing Address - Phone:301-899-2100
Mailing Address - Fax:301-899-3309
Practice Address - Street 1:3611 BRANCH AVE
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-1242
Practice Address - Country:US
Practice Address - Phone:301-899-2100
Practice Address - Fax:301-899-3309
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD6873207R00000X
MDD0022305207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC023061700Medicaid
MD521202860OtherTAX ID
MD34412701OtherBLUESHEILD
DC0468OtherBLUESHEILD
MD972231900Medicaid
DC0468OtherBLUESHEILD
MDB93766Medicare UPIN