Provider Demographics
NPI:1598724783
Name:GOUDARZI, HORMOZE A (MD)
Entity Type:Individual
Prefix:DR
First Name:HORMOZE
Middle Name:A
Last Name:GOUDARZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1721 NEW HANOVER MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-5345
Mailing Address - Country:US
Mailing Address - Phone:910-763-6571
Mailing Address - Fax:910-763-6570
Practice Address - Street 1:1721 NEW HANOVER MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-5345
Practice Address - Country:US
Practice Address - Phone:910-763-6571
Practice Address - Fax:910-763-6570
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC26073208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC203334DOtherMEDICARE PIN
NCC86710Medicare UPIN