Provider Demographics
NPI:1932316908
Name:MASOOD, TAHIRA (MD)
Entity type:Individual
Prefix:
First Name:TAHIRA
Middle Name:
Last Name:MASOOD
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 1:99 CRACKER BARREL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1650
Mailing Address - Country:US
Mailing Address - Phone:304-525-7851
Mailing Address - Fax:
Practice Address - Street 1:376 KENMORE DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25053-7083
Practice Address - Country:US
Practice Address - Phone:304-525-7851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010878792084P0800X
WV239632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry