Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 0101030950 | VA |
NPI | 1053436451 |
---|---|
Provider Name | Hassan Mohagheghi |
First Address | Colonial Heights, VA 23834-1339 |
Second Address | Colonial Heights, VA 23834-1339 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 26/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006062113 | (05) | VA |
B06673 | (02) |