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Organization
MANOOCHEHR MAZLOOMDOOST P S C
Active
Organization
MANOOCHEHR MAZLOOMDOOST P S C
Active
Other names
Wellward
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANESH MAZLOOMDOOST MD (MEDICAL DIRECTOR)
(859) 275-4878
Entity
Organization
Contact information
Practice address
1100 CUMBERLAND FALLS HWY, CORBIN, KY 40701-2715
(859) 275-4878
Mailing address
101 N EAGLE CREEK DR, LEXINGTON, KY 40509-1806
(859) 275-4878
(859) 276-5400
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
NULL
1041C0700X
Clinical Social Worker
—
—
174400000X
Specialist
17083
KY
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
NULL
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
2084P2900X
Pain Medicine (Psychiatry & Neurology) Physician
—
NULL
2084P2900X
Pain Medicine (Psychiatry & Neurology) Physician
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
Other
Enumeration date
03/12/2007
Last updated
08/17/2022
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