Provider Demographics
NPI:1649351289
Name:NAASSANA, MOHSEN RAYMOND (MD)
Entity type:Individual
Prefix:
First Name:MOHSEN
Middle Name:RAYMOND
Last Name:NAASSANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:M.
Other - Middle Name:RAYMOND
Other - Last Name:NAASSANA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14467-0008
Mailing Address - Country:US
Mailing Address - Phone:585-292-5170
Mailing Address - Fax:585-292-5173
Practice Address - Street 1:484 WHITE SPRUCE BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1608
Practice Address - Country:US
Practice Address - Phone:585-292-5170
Practice Address - Fax:585-292-5173
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169785207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY102530CKOtherPREFERRED CARE
NY2058OtherEXCELLUS BCBS
NY0071919OtherGHI
NY01084546Medicaid
5644321OtherAETNA
NY51270BMedicare ID - Type Unspecified
NY0071919OtherGHI