Provider Demographics
NPI:1164460101
Name:HADIDI, MOHAMAD F (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:F
Last Name:HADIDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:785 OHIO AVE
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-6217
Mailing Address - Country:US
Mailing Address - Phone:662-627-2544
Mailing Address - Fax:662-627-2052
Practice Address - Street 1:785 OHIO AVE
Practice Address - Street 2:SUITE 2C
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-6217
Practice Address - Country:US
Practice Address - Phone:662-627-2544
Practice Address - Fax:662-627-2052
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS174272084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00124811Medicaid
AR154530001Medicaid
MS00124811Medicaid