Provider Demographics
NPI:1184710188
Name:QADRI, MASHOOD (DR)
Entity type:Individual
Prefix:MR
First Name:MASHOOD
Middle Name:
Last Name:QADRI
Suffix:
Gender:M
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1600 W. CHANDLER BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6100
Mailing Address - Country:US
Mailing Address - Phone:480-584-3491
Mailing Address - Fax:480-584-4693
Practice Address - Street 1:1637 E MONUMENT PLAZA CIR
Practice Address - Street 2:SUITE 1
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-5600
Practice Address - Country:US
Practice Address - Phone:520-426-1512
Practice Address - Fax:520-876-5261
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY226055207R00000X
AZ36749207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ214680Medicaid
AZZ124754Medicare PIN