Provider Demographics
NPI:1831695915
Name:NOORI, MAHBOUB RAHMAN (MD)
Entity type:Individual
Prefix:
First Name:MAHBOUB
Middle Name:RAHMAN
Last Name:NOORI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20055 LAKE CHABOT RD STE 130
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5332
Mailing Address - Country:US
Mailing Address - Phone:833-444-7622
Mailing Address - Fax:925-225-9520
Practice Address - Street 1:20055 LAKE CHABOT RD STE 130
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5332
Practice Address - Country:US
Practice Address - Phone:833-444-7622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA173453207RH0003X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine