Provider Demographics
NPI:1265542302
Name:TAHERI, MOHAMMAD REZA (MD, PHD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:REZA
Last Name:TAHERI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:M
Other - Middle Name:REZA
Other - Last Name:TAHERI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:834 SW 122ND ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146-2737
Mailing Address - Country:US
Mailing Address - Phone:206-328-4861
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:C-212, BOX 356340
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-6340
Practice Address - Country:US
Practice Address - Phone:206-543-0065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML200083872085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology