Provider Demographics
NPI:1003905654
Name:MUSAVI, MONIR MOFTAKHARI (MD)
Entity type:Individual
Prefix:
First Name:MONIR
Middle Name:MOFTAKHARI
Last Name:MUSAVI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MONIR
Other - Middle Name:
Other - Last Name:MOFTAKHARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 422
Mailing Address - Street 2:ACADIA HOSPITAL CORP
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-0422
Mailing Address - Country:US
Mailing Address - Phone:207-973-6100
Mailing Address - Fax:207-973-6109
Practice Address - Street 1:268 STILLWATER AVENUE
Practice Address - Street 2:ACADIA HOSPITAL CORP
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-973-6100
Practice Address - Fax:207-973-6109
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0160952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
I00728Medicare UPIN
ME0415Medicare ID - Type Unspecified