Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | 24545 | AZ |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 28889 | KY |
N | 208G00000X | Cardiothoracic Vascular Surgeon | G83813 | CA |
NPI | 1053394619 |
---|---|
Provider Name | Hamid R Mohammadzadeh |
First Address | London, KY 40743-0936 |
Second Address | Lexington, KY 40504-3751 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2005 |
Last Update Date | 30/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64288897 | (05) | KY |
F58354 | (02) |