Provider Demographics
NPI:1831101583
Name:ATHARI, MOHAMMAD (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
Last Name:ATHARI
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:PO BOX 935
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77522-0935
Mailing Address - Country:US
Mailing Address - Phone:281-427-2700
Mailing Address - Fax:281-428-2782
Practice Address - Street 1:4310 GARTH RD STE B
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3114
Practice Address - Country:US
Practice Address - Phone:281-427-2700
Practice Address - Fax:281-428-2782
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE67182084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135423503Medicaid
TX88CA14Medicare ID - Type Unspecified
TXB20987Medicare UPIN