Provider Demographics
NPI:1891759833
Name:ELHADDAD, MOHSEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHSEN
Middle Name:A
Last Name:ELHADDAD
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 1:49 STATE RD PEQUOT BLDG #201
Mailing Address - Street 2:
Mailing Address - City:NORTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747
Mailing Address - Country:US
Mailing Address - Phone:508-961-1644
Mailing Address - Fax:508-984-5893
Practice Address - Street 1:49 STATE RD
Practice Address - Street 2:PEQUOT BLDG #201
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-3322
Practice Address - Country:US
Practice Address - Phone:508-961-1644
Practice Address - Fax:508-984-5893
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77609208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3121313Medicaid
MA3121313Medicaid