Provider Demographics
NPI:1477641736
Name:DANESHJOO, PARVIZ (MD)
Entity Type:Individual
Prefix:DR
First Name:PARVIZ
Middle Name:
Last Name:DANESHJOO
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:ONE WYOMING STREET
Mailing Address - Street 2:STE 4110
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409
Mailing Address - Country:US
Mailing Address - Phone:937-208-5241
Mailing Address - Fax:937-208-5242
Practice Address - Street 1:ONE WYOMING STREET
Practice Address - Street 2:STE 4110
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409
Practice Address - Country:US
Practice Address - Phone:937-208-5241
Practice Address - Fax:937-208-5242
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35032931D207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000036333OtherANTHEM
OH0156585Medicaid
2080105OtherAETNA
2080105OtherAETNA
C00865Medicare UPIN