Organization
MANOOCHEHR MAZLOOMDOOST PSC
Active
Other names
Pain Management Medicine, Wellward Regenerative Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANESH MAZLOOMDOOST MD (MEDICAL DIRECTOR)
(859) 275-4878
Entity
Organization
Contact information
Practice address
101 N EAGLE CREEK DR # 120, LEXINGTON, KY 40509-1806
(859) 275-4878
(859) 276-5400
Mailing address
101 N EAGLE CREEK DR # 120, LEXINGTON, KY 40509-1806
(859) 275-4878
(859) 276-5400
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
2084P2900X
Pain Medicine (Psychiatry & Neurology) Physician
—
—
225100000X
Physical Therapist
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65941387
—
KY
Enumeration date
02/06/2006
Last updated
07/18/2024
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