Individual
SHAHRIAR MOOSSAVI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
200200745
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
131PM
BCBS
—
05
—
2004959000
—
WV
05
—
5886881
—
VA
01
—
7407457
AETNA
—
01
—
800195
PARTNERS
—
05
—
89131PM
—
NC
01
—
B7288
MEDCOST
—
05
—
Q0074N
—
SC
Enumeration date
12/08/2005
Last updated
03/22/2013
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