Provider Demographics
NPI:1104913938
Name:JALILVAND, MASOUD (MD)
Entity type:Individual
Prefix:
First Name:MASOUD
Middle Name:
Last Name:JALILVAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 GIVEN RD
Mailing Address - Street 2:CINCINNATI
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45243-2838
Mailing Address - Country:US
Mailing Address - Phone:513-830-7595
Mailing Address - Fax:
Practice Address - Street 1:10506 MONTGOMERY ROAD #201
Practice Address - Street 2:BETHASDA NORTH HOSPITAL
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4415
Practice Address - Country:US
Practice Address - Phone:513-376-0928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH88425207R00000X
OH35.088425208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH88425OtherSTATE LISCENCE #
OH4192686Medicare PIN
OH88425OtherSTATE LISCENCE #