Basic Information
| Provider Information | |||||||||
| NPI: | 1548258346 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VASEF | ||||||||
| FirstName: | MOHAMMED | ||||||||
| MiddleName: | ALI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1650 UNIVERSITY NE | ||||||||
| Address2: | SUITE 116 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 87102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052724814 | ||||||||
| FaxNumber: | 5052728084 | ||||||||
| Practice Location | |||||||||
| Address1: | 2211 LOMAS NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 87131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052724814 | ||||||||
| FaxNumber: | 5052728084 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2005 | ||||||||
| LastUpdateDate: | 08/26/2014 | ||||||||
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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 | 207ZH0000X | 29565 | IA | N | Allopathic & Osteopathic Physicians | Pathology | Hematology | 207ZP0102X | 29565 | IA | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0102X | MD20050718 | NM | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZH0000X | MD20050718 | NM | N | Allopathic & Osteopathic Physicians | Pathology | Hematology | 207ZH0000X | A53441 | CA | N | Allopathic & Osteopathic Physicians | Pathology | Hematology |
ID Information
| ID | Type | State | Issuer | Description | 1162453 | 05 | IA | MEDICAID | 33958 | 01 | IA | WELLMARK BCBS | OTHER | 41638 | 01 | IA | WELLMARK BCBS | OTHER | 0162453 | 05 | IA | MEDICAID |