Provider Demographics
NPI:1275514986
Name:TAGHIZADEH, BEHZAD (MD)
Entity Type:Individual
Prefix:DR
First Name:BEHZAD
Middle Name:
Last Name:TAGHIZADEH
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 1:5555 RESERVOIR DR STE 209
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5186
Mailing Address - Country:US
Mailing Address - Phone:336-414-6079
Mailing Address - Fax:858-771-1534
Practice Address - Street 1:5555 RESERVOIR DR STE 209
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5186
Practice Address - Country:US
Practice Address - Phone:336-414-6079
Practice Address - Fax:858-771-1534
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300293207RC0000X
VA0101232582207RC0000X
CAC58208207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010117321Medicaid
VA010117364Medicaid
VA010116716Medicaid
VA167205OtherANTHEM (W/S)
NC2012405AOtherFMH
NC3155493OtherCIGNA HEALTHCARE
VA010117313Medicaid
3069114OtherAETNA
7275230OtherAETNA
VA010117330Medicaid
VA167299OtherANTHEM (MOCKSVILLE)
NC13338OtherBCBS
VA1275514986Medicaid
VA166458OtherANTHEM (STUART)
VA166719OtherANTHEM (MT. AIRY)
VA166007OtherANTHEM (GALAX)
NC8913338Medicaid
NC2012405AOtherFMH
VA166458OtherANTHEM (STUART)
VA166719OtherANTHEM (MT. AIRY)
VA1275514986Medicaid