Provider Demographics
NPI:1275559304
Name:MASOUDPOUR, ESMAIL (MD)
Entity type:Individual
Prefix:DR
First Name:ESMAIL
Middle Name:
Last Name:MASOUDPOUR
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 1:7211 HANOVER PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770
Mailing Address - Country:US
Mailing Address - Phone:301-220-3000
Mailing Address - Fax:301-220-3005
Practice Address - Street 1:7211 HANOVER PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770
Practice Address - Country:US
Practice Address - Phone:301-220-3000
Practice Address - Fax:301-220-3005
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD12815207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404491600Medicaid
MD404491600Medicaid
G01382Medicare ID - Type Unspecified