Basic Information
| Provider Information | |||||||||
| NPI: | 1518907310 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MASTALI | ||||||||
| FirstName: | KOUROSH | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | KOHNEH | ||||||||
| OtherFirstName: | KOUROSH | ||||||||
| OtherMiddleName: | MASTALI MAJDABAD | ||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1838 GREENE TREE RD | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212086391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106029262 | ||||||||
| FaxNumber: | 4106029276 | ||||||||
| Practice Location | |||||||||
| Address1: | 7501 OSLER DR | ||||||||
| Address2: | THIRD FLOOR | ||||||||
| City: | TOWSON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212047733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105831170 | ||||||||
| FaxNumber: | 4105831267 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 01/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | D0064509 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | D0064509 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
No ID Information.