Manoochehr Mazloomdoost, MD

Primary specialty

Pain Medicine PhysicianTaxonomy code 208VP0000X

License

17083 Issued in KY

Practice address

715 Shaker Dr
Ste 101 Pain Management Medicine
Lexington, KY 40504

Phone

(859) 275-4878

Fax

(859) 276-5400

NPI assigned

Feb 1, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1740252188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 SHAKER DR",
            "address_2": "STE 101 PAIN MANAGEMENT MEDICINE",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "40504",
            "telephone_number": "859-275-4878",
            "fax_number": "859-276-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 SHAKER DR",
            "address_2": "STE 101 PAIN MANAGEMENT MEDICINE",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "40504",
            "telephone_number": "859-275-4878",
            "fax_number": "859-276-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZLOOMDOOST",
        "first_name": "MANOOCHEHR",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "KY",
            "license": "17083",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64170830",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000000069094",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karleigh Maze
• Suze Marie Maze, LCSW, CCGC, CEAP
• Whitley Ashton Maze, CRNA
• Camellia Mazloomdoost, MD
• Danesh Mazloomdoost, MD
• Alison Mazurak
• Alberto Mazzoleni, M.D.
• Emmy Obinna Mbagwu
• MBM Psychological Services, PLLC
• Abigail Powers MC Caughley, PA-C

• Pain Medicine Physician in Lexington, KY
• Providers in Lexington, KY by specialty
• Pain Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.