Provider Demographics
NPI:1003095472
Name:MOAYERI, MOHAMMAD A (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:A
Last Name:MOAYERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALI
Other - Middle Name:
Other - Last Name:MOAYERI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:12000 MCCRACKEN RD
Mailing Address - Street 2:STE 211
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2964
Mailing Address - Country:US
Mailing Address - Phone:216-587-4189
Mailing Address - Fax:216-587-4850
Practice Address - Street 1:5706 TURNEY RD
Practice Address - Street 2:STE 206
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-3928
Practice Address - Country:US
Practice Address - Phone:216-587-4189
Practice Address - Fax:216-587-4850
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044515207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0507615Medicaid
OH0507615Medicaid
OH0522722Medicare PIN