Provider Demographics
NPI:1891912754
Name:BOGHDADI, MONA SALEH (MD)
Entity Type:Individual
Prefix:DR
First Name:MONA
Middle Name:SALEH
Last Name:BOGHDADI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 48315
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-0120
Mailing Address - Country:US
Mailing Address - Phone:813-907-7680
Mailing Address - Fax:813-907-2454
Practice Address - Street 1:27348 CASHFORD CIR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-8198
Practice Address - Country:US
Practice Address - Phone:813-907-7680
Practice Address - Fax:913-907-2454
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78034207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH00199Medicare UPIN
FL47061Medicare ID - Type Unspecified