Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 282225 | NY |
N | 207RR0500X | Rheumatology | 282225 | NY |
NPI | 1093013781 |
---|---|
Provider Name | Dr. Mahta Mortezavi |
First Address | Rochester, NY 14607-4047 |
Second Address | Rochester, NY 14607-4047 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2011 |
Last Update Date | 16/08/2017 |