Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 0101253093 | VA |
N | 2080P0210X | Pediatric Nephrologist | 048941 | CT |
NPI | 1639483373 |
---|---|
Provider Name | Davoud Mohtat |
First Address | Bethesda, MD 20817-1251 |
Second Address | Fairfax, VA 22031-2207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2010 |
Last Update Date | 19/10/2020 |