Active NPI
Mahmoud Ghaderi, DO
- Otolaryngology Physician
- Darby, PA
National Provider Identifier
1689645632
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(2) exclusion effective May 20, 2019.
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- OS008674L
- Practice address
- 1501 Lansdowne Ave Ste 209
Darby, PA 19023-1333 - Phone
- (484) 494-5595
- NPI assigned
- Jan 29, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | OS008674L | PA | Primary |
Addresses
Primary practice location
1501 Lansdowne Ave Ste 209
Darby, PA 19023-1333
Mailing address
175 W Cohawkin Rd Ste C
Clarksboro, NJ 08020-1145
Phone (856) 423-7700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0018130520010 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138492800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1394409600000",
"number": "1689645632",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "175 W COHAWKIN RD STE C",
"city": "CLARKSBORO",
"state": "NJ",
"postal_code": "080201145",
"telephone_number": "856-423-7700",
"fax_number": "856-423-0823"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 LANSDOWNE AVE STE 209",
"city": "DARBY",
"state": "PA",
"postal_code": "190231333",
"telephone_number": "484-494-5595"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GHADERI",
"first_name": "MAHMOUD",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-29",
"last_updated": "2014-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "PA",
"license": "OS008674L",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0018130520010",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Darby, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.