Provider Demographics
NPI:1144734492
Name:ALIGHOLIZADEH, KUROUSH (CRNP)
Entity type:Individual
Prefix:MR
First Name:KUROUSH
Middle Name:
Last Name:ALIGHOLIZADEH
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 BERANS RD
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-1501
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:410-825-2529
Practice Address - Street 1:2702 BACK ACRE CIR
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-7769
Practice Address - Country:US
Practice Address - Phone:410-245-0921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-23
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR172732207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine