Individual
DR. KEIVAN ETTEFAGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2707 HENRY ST, GREENSBORO, NC 27405
(336) 574-4280
(336) 574-4634
Mailing address
2707 HENRY ST, GREENSBORO, NC 27405-3669
(336) 574-4280
(336) 574-4634
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2018-00348
NC
208000000X
Pediatrics Physician
MD07109
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9002176
—
RI
Enumeration date
06/28/2005
Last updated
05/16/2018
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