Provider Demographics
NPI:1437146628
Name:GHANDNOOSH, AZIZ (MD)
Entity Type:Individual
Prefix:
First Name:AZIZ
Middle Name:
Last Name:GHANDNOOSH
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 1:111 MEMORIAL DR
Mailing Address - Street 2:PEDIATRIC CENTER
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-1518
Mailing Address - Country:US
Mailing Address - Phone:864-848-7005
Mailing Address - Fax:864-848-3666
Practice Address - Street 1:111 MEMORIAL DR
Practice Address - Street 2:PEDIATRIC CENTER
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1518
Practice Address - Country:US
Practice Address - Phone:864-848-7005
Practice Address - Fax:864-848-3666
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18570208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G27959Medicare UPIN
SCT26745Medicare ID - Type Unspecified