Provider Demographics
NPI:1255598835
Name:HOSSEINI, SEYEDEH (MD)
Entity type:Individual
Prefix:
First Name:SEYEDEH
Middle Name:
Last Name:HOSSEINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 BROOKFIELD LN
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-3648
Mailing Address - Country:US
Mailing Address - Phone:215-667-9620
Mailing Address - Fax:413-726-6304
Practice Address - Street 1:1400 STATE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01109-2550
Practice Address - Country:US
Practice Address - Phone:413-726-6702
Practice Address - Fax:413-726-6304
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA241860207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110083972/AMedicaid
MA241860OtherLICENSE
11995464OtherCAQH
MA110083972/AMedicaid