Provider Demographics
NPI:1346510682
Name:GHADIMI, KAMROUZ (MD)
Entity Type:Individual
Prefix:
First Name:KAMROUZ
Middle Name:
Last Name:GHADIMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KAMROOZ
Other - Middle Name:
Other - Last Name:GHADIMI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 63362
Mailing Address - Street 2:CHARLOTTE
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3362
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2301 ERWIN RD
Practice Address - Street 2:DURHAM
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4699
Practice Address - Country:US
Practice Address - Phone:919-681-6532
Practice Address - Fax:919-681-8994
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD444277207L00000X
NC2014-00584207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology