Provider Demographics
NPI:1720022023
Name:MOSTAGHIM, RADMAN (MD)
Entity Type:Individual
Prefix:
First Name:RADMAN
Middle Name:
Last Name:MOSTAGHIM
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 1:7305 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:301-982-4465
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:301-982-4465
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0046093207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD110083708OtherRAILROAD MEDICARE
MD287603OtherALLIANCE/MAMSI
MD23011OtherJOHNS HOPKINS HEALTHCARE
MD4566293OtherAETNA
MD1720022023OtherSOLO NPI# 1720022023
DC185840OtherDC MEDICARE GROUP PTAN
MD1421392OtherCIGNA
MD4768 0001OtherCAREFIRST
DC570371OtherDC MEDICARE SOLO PTAN
MD1942526561OtherGROUP NPI #1942526561
MD342351400Medicaid
MD1942526561OtherGROUP NPI #1942526561