Provider Demographics
NPI:1942539085
Name:SERAJI, MEHRZAD (MD)
Entity Type:Individual
Prefix:
First Name:MEHRZAD
Middle Name:
Last Name:SERAJI
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 1:1040 N MASON RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6366
Mailing Address - Country:US
Mailing Address - Phone:314-985-8035
Mailing Address - Fax:314-985-8034
Practice Address - Street 1:1040 N MASON RD STE 201
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6366
Practice Address - Country:US
Practice Address - Phone:314-985-8035
Practice Address - Fax:314-985-8034
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-21
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20140296732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1942539085Medicaid
MO1942539085Medicare PIN