Provider Demographics
NPI:1851596209
Name:MOINUDDIN, MASARRATH JAHAN
Entity Type:Individual
Prefix:
First Name:MASARRATH
Middle Name:JAHAN
Last Name:MOINUDDIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MASARRATH
Other - Middle Name:JAHAN
Other - Last Name:MOINUDDIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3999 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-6046
Mailing Address - Country:US
Mailing Address - Phone:216-593-5500
Mailing Address - Fax:
Practice Address - Street 1:232 MAEVE CT
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-7944
Practice Address - Country:US
Practice Address - Phone:636-527-5959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-17
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35087013207RC0000X
MO2006015222207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease