Provider Demographics
NPI:1548258346
Name:VASEF, MOHAMMED ALI (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:ALI
Last Name:VASEF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 UNIVERSITY NE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102
Mailing Address - Country:US
Mailing Address - Phone:505-272-4814
Mailing Address - Fax:505-272-8084
Practice Address - Street 1:2211 LOMAS NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131
Practice Address - Country:US
Practice Address - Phone:505-272-4814
Practice Address - Fax:505-272-8084
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD20050718207ZH0000X, 207ZP0102X
IA29565207ZP0102X, 207ZH0000X
CAA53441207ZH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0162453Medicaid
IA1162453Medicaid
IA41638OtherWELLMARK BCBS
IA33958OtherWELLMARK BCBS
F89565Medicare UPIN
IA41638Medicare ID - Type Unspecified
IA1162453Medicaid