Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | D77423 | MD |
Y | 2084N0400X | Neurologist | MD472157 | PA |
NPI | 1013159326 |
---|---|
Provider Name | Dr. Mohammad Ali Khoshnoodi |
First Address | Reading, PA 19612-3579 |
Second Address | West Reading, PA 19611-1450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2009 |
Last Update Date | 23/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080478900 | (05) | MD |
1038638060001 | (05) | PA |