MANOOCHER MOFIDI (NPI# 1013934959) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013934959 |
| Entity Type | Individual |
| Full Name | MANOOCHER MOFIDI |
| Credential | MD |
| Practice Address |
2225 W Broadway Louisville KY 40211-1003 |
| Mailing Address |
101 W Muhammad Ali Blvd Louisville KY 40202-1423 |
| Practice Telephone | 5025898600 |
| Practice Fax Number | 5025898771 |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2013-02-13 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
01037544A | IN | Allopathic & Osteopathic Physicians |
| Y | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
25630 | KY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200189820A | 05 |
| Street Address |
2225 W BROADWAY |
| City | LOUISVILLE |
| State | KY |
| Zip Code | 40211-1003 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396274965 | Angela Rudd | Pharmacist | 2225 W Broadway, Louisville, KY 40211-1003 | 2017-06-07 |
| 1164839940 | Tessa Stephens | Social Worker | 2225 W Broadway, Louisville, KY 40211-1003 | 2014-07-14 |
| 1326459934 | Candace Bell | Marriage & Family Therapist | 2225 W Broadway, Louisville, KY 40211-1003 | 2014-05-16 |
| 1568873552 | Amna Amir | Counselor | 2225 W Broadway, Louisville, KY 40211-1003 | 2014-05-13 |
| 1225452253 | Ziberia Persley | Nurse's Aide | 2225 W Broadway, Louisville, KY 40211-1003 | 2014-02-11 |
| 1114365590 | Kimberly Joell Bates | Counselor | 2225 W Broadway, Louisville, KY 40211-1003 | 2013-06-07 |
| 1033556246 | Paige Brown | Student in an Organized Health Care Education/Training Program | 2225 W Broadway, Louisville, KY 40211-1003 | 2013-05-29 |
| 1124462023 | Rashaad Abdur-rahman | Social Worker | 2225 W Broadway, Louisville, KY 40211-1003 | 2013-04-22 |
| 1447503727 | Shermeka Wallace | Social Worker | 2225 W Broadway, Louisville, KY 40211-1003 | 2012-10-24 |
| 1073863924 | Reza Gharachamani Asl | Case Manager/Care Coordinator | 2225 W Broadway, Louisville, KY 40211-1003 | 2012-09-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942792940 | Kare LLC | Dentist | 2500 W Broadway Ste 500, Louisville, KY 40211 | 2018-06-05 |
| 1265943716 | Practicare Home Care Services, LLC | Nurse Practitioner | 1667 Russell Lee Dr, Louisville, KY 40211 | 2017-10-23 |
| 1518478221 | Latoya Samantha Hall | Counselor | 646 South 36th Street, Louisville, KY 40211 | 2017-10-20 |
| 1003071200 | Mark Cassol Md Psc | Ophthalmology | 2600 W. Broadway, Suite 105, Louisville, KY 40211 | 2008-07-28 |
| 1194919548 | Hardin Housing Corp | Assisted Living Facility | 2035 S 41st St, Louisville, KY 40211 | 2007-08-29 |
| 1184770562 | Eta Day Care Center LLC | Case Management | 724 So 44th Street, Louisville, KY 40211 | 2007-01-26 |
| 1871571356 | Alice C Gunnison | Physician Assistant | 2406 West Broadway, Jencare Neighborhood Medical Center West Broadway, LLC, Louisville, KY 40211 | 2006-01-05 |
| 1730733783 | Mark A Bush | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211 | 2019-07-29 |
| 1407419237 | Gina M Beckford | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211 | 2019-04-17 |
| 1730694266 | Orchid House, Inc. | Early Intervention Provider Agency | 703 S 31st St, Louisville, KY 40211 | 2017-12-06 |
| Find all providers in zip 40211 | ||||
| Taxonomy Code | 2084P0804X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Child & Adolescent Psychiatry |
| Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356736896 | Tymberly Seim | Psychiatry & Neurology | 200 E Chestnut St Ste 200, Louisville, KY 40202-1847 | 2015-04-01 |
| 1285037713 | Courtney Brown Snyder | Psychiatry & Neurology | 5223 Indian Woods Dr, Louisville, KY 40207-2078 | 2014-09-29 |
| 1629416854 | Ball Consulting, Inc | Psychiatry & Neurology | 732 Greenridge Ln, Louisville, KY 40207-1331 | 2013-06-10 |
| 1487859757 | Marcy Cooper | Psychiatry & Neurology | 1314 Main St Unit 204, Louisville, CO 80027-1586 | 2007-06-18 |
| 1154458776 | Christine Beate Lieber Adams | Psychiatry & Neurology | 1430 Sylvan Way, Louisville, KY 40205-2484 | 2007-02-28 |
| 1851432199 | Julia M. Robertson | Psychiatry & Neurology | 3 River Hill Rd, Louisville, KY 40207-1191 | 2007-02-09 |
| 1124046552 | Elvira Drljevic Md Psc | Psychiatry & Neurology | 3814 Stone River Ct, Louisville, KY 40299-6543 | 2006-07-17 |
| 1861426991 | Elizabeth Caudill | Psychiatry & Neurology | 3717 Taylorsville Rd, Louisville, KY 40220-1333 | 2006-07-11 |
| 1881635076 | Timothy D. Peters | Psychiatry & Neurology | 714 Lyndon Ln Ste 6, Louisville, KY 40222-4643 | 2006-06-09 |
| 1003890666 | Alphonso Nichols IIi | Psychiatry & Neurology | 3121 Brooklawn Campus Dr, Louisville, KY 40218-1282 | 2005-12-06 |
| Find all providers in LOUISVILLE | ||||
| City | LOUISVILLE |
| Zip Code | 40211 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.