| Doctor Name: | DR. MAHBOD MOHAZZEBI |
| NPI Number: | 1538319827 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 249516 |
| Business Practice Address: | 710 Kresson Rd Cherry Hill, NJ - 080032604 |
| Business Phone Number: | 8567953320 |
| Business Fax Number: | 8567951213 |
| Mailing Address: | 402 Lippincott Dr, MARLTON |
| State: | NJ |
| Postal Code: | 080534112 |
| Phone Number: | 8567823300 |
| Fax Number: | 8565048029 |
| NPI Enumeration Date: | 09/24/2008 |
| NPI Last Update Date: | 05/25/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | 249516 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |