Provider Demographics
NPI:1073597233
Name:FOROUZANNIA, AFSHIN (MD)
Entity Type:Individual
Prefix:
First Name:AFSHIN
Middle Name:
Last Name:FOROUZANNIA
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 1:2501 N ORANGE AVE STE 182
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4675
Mailing Address - Country:US
Mailing Address - Phone:407-303-5857
Mailing Address - Fax:407-303-4782
Practice Address - Street 1:2501 N ORANGE AVE STE 182
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4675
Practice Address - Country:US
Practice Address - Phone:407-303-5857
Practice Address - Fax:407-303-4782
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83880174400000X, 2085R0001X, 2085R0203X
FLME1231732085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A838800Medicaid
CAWA83880HMedicare PIN
CAWA83880IMedicare PIN
CAWA83380BMedicare PIN
CAWA83880DMedicare PIN
CAWA83880FMedicare PIN
CA00A838800Medicaid
CAWA83880CMedicare PIN
CAWA83880KMedicare PIN
CA00A838800Medicare PIN
CAA83880Medicare UPIN
CAWA83880EMedicare PIN