Provider Demographics
NPI:1376594150
Name:MOOSAVY, FARID M (MD)
Entity Type:Individual
Prefix:
First Name:FARID
Middle Name:M
Last Name:MOOSAVY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4745 OGLETOWN STANTON RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2067
Mailing Address - Country:US
Mailing Address - Phone:302-623-7600
Mailing Address - Fax:302-366-1240
Practice Address - Street 1:4745 OGLETOWN STANTON RD
Practice Address - Street 2:SUITE 220
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2067
Practice Address - Country:US
Practice Address - Phone:302-623-7600
Practice Address - Fax:302-366-1240
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2013-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DEC10007769207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
1108627OtherAETNA/USHC
2690976000OtherAMERIHEALTH/KEYSTONE
411415OtherCOVENTRY
9855585OtherCIGNA
DE1000038313Medicaid
2690976000OtherINDEPENDENCE BCBS
MD64767501OtherCAREFIRST BCBS
1108627OtherAETNA/USHC
2690976000OtherINDEPENDENCE BCBS