Provider Demographics
NPI:1083153894
Name:NADERI MEHR, MANDANA (MD)
Entity type:Individual
Prefix:
First Name:MANDANA
Middle Name:
Last Name:NADERI MEHR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 CHESTNUT STREET
Mailing Address - Street 2:2ND FL
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-2049
Mailing Address - Fax:413-794-1629
Practice Address - Street 1:21 DWIGHT ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1765
Practice Address - Country:US
Practice Address - Phone:413-795-4555
Practice Address - Fax:413-794-9448
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA292789207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine