Provider Demographics
NPI:1891180998
Name:MOFIDIAN, MEHDI (MD)
Entity Type:Individual
Prefix:
First Name:MEHDI
Middle Name:
Last Name:MOFIDIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SEYEDMEHDI
Other - Middle Name:
Other - Last Name:MOFIDIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 ATWELL ROAD
Mailing Address - Street 2:DEPARTMENT OF MEDICINE, HOSPITALIST DIVISION
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326
Mailing Address - Country:US
Mailing Address - Phone:607-547-4586
Mailing Address - Fax:
Practice Address - Street 1:1 ATWELL ROAD
Practice Address - Street 2:DEPARTMENT OF MEDICINE, HOSPITALIST DIVISION
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326
Practice Address - Country:US
Practice Address - Phone:607-547-4586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2020-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295293207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine