Provider Demographics
NPI:1881845253
Name:GHADIMI-MAHANI, MOHSEN (MD)
Entity Type:Individual
Prefix:
First Name:MOHSEN
Middle Name:
Last Name:GHADIMI-MAHANI
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 1:1710 E SAUNDERS ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-5443
Mailing Address - Country:US
Mailing Address - Phone:956-796-3580
Mailing Address - Fax:956-796-3582
Practice Address - Street 1:1710 E. SAUNDERS ST. SUITE A 140
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041
Practice Address - Country:US
Practice Address - Phone:956-796-3580
Practice Address - Fax:956-796-3582
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX000000207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology