Provider Demographics
NPI:1588015564
Name:MAZRAEH, DALAL (MD)
Entity Type:Individual
Prefix:
First Name:DALAL
Middle Name:
Last Name:MAZRAEH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 5TH AVE
Mailing Address - Street 2:1ST FLOOR KELLY BUILDING
Mailing Address - City:MCKEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15132-2422
Mailing Address - Country:US
Mailing Address - Phone:412-664-2782
Mailing Address - Fax:412-664-2784
Practice Address - Street 1:1500 5TH AVE
Practice Address - Street 2:1ST FLOOR KELLY BUILDING
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15132-2422
Practice Address - Country:US
Practice Address - Phone:412-664-2782
Practice Address - Fax:412-664-2784
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA277687207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine