Provider Demographics
NPI:1912195918
Name:MOBASHERY, NILOUFAR (MD)
Entity Type:Individual
Prefix:DR
First Name:NILOUFAR
Middle Name:
Last Name:MOBASHERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 DENNISON RD
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:CT
Mailing Address - Zip Code:06426-1350
Mailing Address - Country:US
Mailing Address - Phone:408-705-7193
Mailing Address - Fax:
Practice Address - Street 1:50 PEQUOT AVE
Practice Address - Street 2:MS 6025-B3125
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-5410
Practice Address - Country:US
Practice Address - Phone:860-732-1033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79219174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist