Basic Information
| Provider Information | |||||||||
| NPI: | 1093013781 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORTEZAVI | ||||||||
| FirstName: | MAHTA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 222 ALEXANDER ST | ||||||||
| Address2: | STE 3000 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146074047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859228350 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 222 ALEXANDER ST STE 3000 | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146074047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859228350 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2011 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | 282225 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | 207RA0201X | 282225 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Allergy & Immunology |
No ID Information.