Individual
MANDANA MAHMOODI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
15 CRAWFORD ST STE 100, NEEDHAM, MA 02494-2618
(617) 969-4100
Mailing address
PO BOX 840294, DALLAS, TX 75284-0294
Taxonomy
Speciality
Code
Description
License number
State
207ZD0900X
Dermatopathology (Pathology) Physician
Primary
233840
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
800887
HARVARD PILGRIM HEALTH CA
MA
05
—
9787194
—
MA
01
—
M17162
BLUE CROSS
MA
Enumeration date
10/12/2007
Last updated
03/21/2018
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