Provider Demographics
NPI:1699730382
Name:ALAVI, MOSEN (MD)
Entity type:Individual
Prefix:
First Name:MOSEN
Middle Name:
Last Name:ALAVI
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 1:531 CONSHOHOCKEN STATE RD
Mailing Address - Street 2:
Mailing Address - City:GLADWYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19035-1423
Mailing Address - Country:US
Mailing Address - Phone:610-645-8312
Mailing Address - Fax:215-707-1157
Practice Address - Street 1:100 E LEHIGH AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-1000
Practice Address - Country:US
Practice Address - Phone:215-707-1160
Practice Address - Fax:215-707-1157
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035334Y207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001074116Medicaid
E11464Medicare UPIN