Individual
MANA MOGHADAMFALAHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1850 STATE ST, NEW ALBANY, IN 47150-4990
(812) 948-4325
(502) 456-4440
Mailing address
PO BOX 1286, NEW ALBANY, IN 47151-1286
(502) 456-6211
(502) 456-4440
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
01073646A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000875489
ANTHEM
KY
05
—
201153720A
—
IN
01
—
50083645
PASSPORT
KY
05
—
7100240630
—
KY
Enumeration date
05/23/2007
Last updated
05/05/2015
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