Provider Demographics
NPI:1740236793
Name:MOTAMED, MEHRDAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MEHRDAD
Middle Name:
Last Name:MOTAMED
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 1:701 LONGVIEW ROAD
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079
Mailing Address - Country:US
Mailing Address - Phone:973-761-0443
Mailing Address - Fax:401-728-3920
Practice Address - Street 1:701 LONGVIEW ROAD
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079
Practice Address - Country:US
Practice Address - Phone:973-761-0443
Practice Address - Fax:401-728-3920
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI4442207X00000X
NJ25MA091265000207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1780672709OtherORGANIZATION NPI#
RI007000918Medicare ID - Type Unspecified
1780672709OtherORGANIZATION NPI#
087168Medicare UPIN