Provider Demographics
NPI:1023051307
Name:KHORSANDI, MARK DARIUS (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:DARIUS
Last Name:KHORSANDI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 W GRAY ST
Mailing Address - Street 2:STE. B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-4019
Mailing Address - Country:US
Mailing Address - Phone:713-522-5111
Mailing Address - Fax:713-522-6111
Practice Address - Street 1:810 WAUGH DR STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-2013
Practice Address - Country:US
Practice Address - Phone:713-522-5111
Practice Address - Fax:713-522-6111
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO1445207XS0106X
FLOS9504208600000X
NY219738208600000X
AZ45872086S0105X
TXM7331207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand