Provider Demographics
NPI:1013050939
Name:GHARAVI, MOHAMMAD HOSSEIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:HOSSEIN
Last Name:GHARAVI
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 1:51 S MAIN AVE
Mailing Address - Street 2:SUITE 318
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3952
Mailing Address - Country:US
Mailing Address - Phone:727-572-6261
Mailing Address - Fax:727-443-2501
Practice Address - Street 1:51 S MAIN AVE
Practice Address - Street 2:SUITE 318
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3952
Practice Address - Country:US
Practice Address - Phone:727-572-6261
Practice Address - Fax:727-443-2501
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111254207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA491404Medicare ID - Type UnspecifiedPHYSICAL THERAPY
MD011SMedicare ID - Type UnspecifiedPHYSICAL THERAPY