Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD434388 | PA |
Y | 2080P0214X | Pediatric Pulmonologist | MD434388 | PA |
N | 2080P0214X | Pediatric Pulmonologist | MT205387 | PA |
NPI | 1225235237 |
---|---|
Provider Name | Lida Mohtasham |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2007 |
Last Update Date | 02/12/2014 |