Provider Demographics
NPI:1831194521
Name:ZIASHAKERI, MAHMOUD (DC,CCST)
Entity type:Individual
Prefix:DR
First Name:MAHMOUD
Middle Name:
Last Name:ZIASHAKERI
Suffix:
Gender:M
Credentials:DC,CCST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12417 OCEAN GTWY
Mailing Address - Street 2:STE 2A
Mailing Address - City:OCEAN CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21842-9522
Mailing Address - Country:US
Mailing Address - Phone:410-213-1233
Mailing Address - Fax:410-213-1234
Practice Address - Street 1:12417 OCEAN GTWY
Practice Address - Street 2:STE 2A
Practice Address - City:OCEAN CITY
Practice Address - State:MD
Practice Address - Zip Code:21842-9522
Practice Address - Country:US
Practice Address - Phone:410-213-1233
Practice Address - Fax:410-213-1234
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2012-05-09
Deactivation Date:2006-03-31
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
MD01333PT111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT2490001OtherCAREFIRST FEP BC/BS
MDH498OtherCAREFIRST BC/BS
MD658QMedicare ID - Type Unspecified
MDH498OtherCAREFIRST BC/BS