Provider Demographics
NPI:1336554468
Name:MEMARSADEGHI, MAHBOOBEH (MD)
Entity type:Individual
Prefix:
First Name:MAHBOOBEH
Middle Name:
Last Name:MEMARSADEGHI
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 1:8050 INVERNESS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-4011
Mailing Address - Country:US
Mailing Address - Phone:301-610-7504
Mailing Address - Fax:
Practice Address - Street 1:344 UNIVERSITY BLVD W STE 324
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901
Practice Address - Country:US
Practice Address - Phone:301-754-0314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-27
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101257192207R00000X
MDD0078104207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine