Provider Demographics
NPI:1396718722
Name:MOSTAFAVI, ARMAGHAN A (MD)
Entity type:Individual
Prefix:
First Name:ARMAGHAN
Middle Name:A
Last Name:MOSTAFAVI
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 1:1880 N CONGRESS AVE
Mailing Address - Street 2:SUITE# 301
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8671
Mailing Address - Country:US
Mailing Address - Phone:561-424-5004
Mailing Address - Fax:561-424-2689
Practice Address - Street 1:1880 N CONGRESS AVE
Practice Address - Street 2:SUITE# 301
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426
Practice Address - Country:US
Practice Address - Phone:561-424-5004
Practice Address - Fax:561-424-2689
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0076433208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255005900Medicaid
FL255005900Medicaid
43924YMedicare ID - Type Unspecified