Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | C10001859 | DE |
NPI | 1023192713 |
---|---|
Provider Name | Mir Mousavi |
First Address | Seaford, DE 19973-3600 |
Second Address | Seaford, DE 19973-3600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000019401 | (05) | DE |
0000019401 | DPCI (01) | DE |
0097634000 | AMERIHEALTH (01) | DE |
340011 | MAMSI,ALLIANCE,OPT CHOICE (01) | DE |
41834801 | CAREFIRST (01) | DE |
4275023 | AETNA (01) | DE |
B66589 | (02) | DE |
B66589 | BCBS DE (01) | DE |
G254001 | BCBS DC (01) | DE |