# MANOOCHEHR MAZLOOMDOOST P S C

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Wellward
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720110182
- **Authorized official:** DR. DANESH MAZLOOMDOOST MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (859) 275-4878

## Contact information

- **Practice address:** 1100 CUMBERLAND FALLS HWY, CORBIN, KY 40701-2715
- **Practice address phone:** (859) 275-4878
- **Mailing address:** 101 N EAGLE CREEK DR, LEXINGTON, KY 40509-1806
- **Mailing address phone:** (859) 275-4878
- **Mailing address fax:** (859) 276-5400

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 174400000X | Specialist | 17083 | KY | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | Yes |
| 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