Provider Demographics
NPI:1013235894
Name:MASSOUD B. ALIZADEH M.D.,PA
Entity Type:Organization
Organization Name:MASSOUD B. ALIZADEH M.D.,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MASSOUD
Authorized Official - Middle Name:B
Authorized Official - Last Name:ALIZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-739-8049
Mailing Address - Street 1:240 FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6100
Mailing Address - Country:US
Mailing Address - Phone:301-739-8049
Mailing Address - Fax:301-733-3287
Practice Address - Street 1:240 FREDERICK ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6100
Practice Address - Country:US
Practice Address - Phone:301-739-8049
Practice Address - Fax:301-733-3287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD14800261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD004361300Medicaid
MDD74552Medicare UPIN
MD004361300Medicaid