Provider Demographics
NPI:1760986905
Name:MOGHBEL, MATEEN COLLIS (MD)
Entity type:Individual
Prefix:
First Name:MATEEN
Middle Name:COLLIS
Last Name:MOGHBEL
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 1:331 OAK MANOR DR STE 102
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5553
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:331 OAK MANOR DR STE 102
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5553
Practice Address - Country:US
Practice Address - Phone:443-333-1894
Practice Address - Fax:443-333-1894
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2025-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2859402085R0202X
MDD01051282085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology