Provider Demographics
NPI:1639520133
Name:MOGADAM, EMAD
Entity type:Individual
Prefix:
First Name:EMAD
Middle Name:
Last Name:MOGADAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2385 E PRATER WAY STE 302
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-9638
Mailing Address - Country:US
Mailing Address - Phone:775-356-4514
Mailing Address - Fax:775-356-4991
Practice Address - Street 1:2385 E PRATER WAY STE 302
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-9638
Practice Address - Country:US
Practice Address - Phone:775-356-4514
Practice Address - Fax:775-356-4991
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-26
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH24198207RC0000X
NV26369207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease