Provider Demographics
NPI:1588627160
Name:MOSSADEGH, MAHSA (MD)
Entity Type:Individual
Prefix:
First Name:MAHSA
Middle Name:
Last Name:MOSSADEGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9200 PINECROFT DR
Mailing Address - Street 2:STE 220
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3279
Mailing Address - Country:US
Mailing Address - Phone:281-296-7377
Mailing Address - Fax:281-296-7255
Practice Address - Street 1:9200 PINECROFT DR
Practice Address - Street 2:STE 220
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3279
Practice Address - Country:US
Practice Address - Phone:281-296-7377
Practice Address - Fax:281-296-7255
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL7059208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163752206Medicaid
TX163752206Medicaid
TX339361ZX5EMedicare PIN
TX8C6209Medicare ID - Type Unspecified