Provider Demographics
NPI:1053436451
Name:MOHAGHEGHI, HASSAN (MD)
Entity type:Individual
Prefix:
First Name:HASSAN
Middle Name:
Last Name:MOHAGHEGHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 BOULEVARD
Mailing Address - Street 2:SUITE H
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-1339
Mailing Address - Country:US
Mailing Address - Phone:804-520-8932
Mailing Address - Fax:
Practice Address - Street 1:3701 BOULEVARD
Practice Address - Street 2:SUITE H
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1339
Practice Address - Country:US
Practice Address - Phone:804-520-8932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101030950207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006062113Medicaid
VA006062113Medicaid
B06673Medicare UPIN
030000003 C05531Medicare PIN