Provider Demographics
NPI:1881663441
Name:GHAZIASKAR, KOJASTEH MAHSA (MD)
Entity Type:Individual
Prefix:DR
First Name:KOJASTEH
Middle Name:MAHSA
Last Name:GHAZIASKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6142 E BROWN RD
Mailing Address - Street 2:102
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-4962
Mailing Address - Country:US
Mailing Address - Phone:480-396-2087
Mailing Address - Fax:480-396-3973
Practice Address - Street 1:6142 E BROWN RD
Practice Address - Street 2:102
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4962
Practice Address - Country:US
Practice Address - Phone:480-396-2087
Practice Address - Fax:480-396-3973
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ34309208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics