Provider Demographics
NPI:1639483373
Name:MOHTAT, DAVOUD (MD)
Entity Type:Individual
Prefix:
First Name:DAVOUD
Middle Name:
Last Name:MOHTAT
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 1:7146 SWANSONG WAY
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1251
Mailing Address - Country:US
Mailing Address - Phone:347-267-0858
Mailing Address - Fax:
Practice Address - Street 1:3023 HAMAKER CT
Practice Address - Street 2:SUITE 600
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2207
Practice Address - Country:US
Practice Address - Phone:703-876-2788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0489412080P0210X
VA01012530932080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology