Provider Demographics
NPI:1669448171
Name:MOQEETH, SYED A (MD)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:A
Last Name:MOQEETH
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:PO BOX 638196
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-8196
Mailing Address - Country:US
Mailing Address - Phone:513-569-6780
Mailing Address - Fax:513-789-8491
Practice Address - Street 1:619 OAK ST
Practice Address - Street 2:STE 645
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-1613
Practice Address - Country:US
Practice Address - Phone:513-569-6780
Practice Address - Fax:513-789-8491
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-067595207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200293560 AMedicaid
OHP00004639OtherRR MEDICARE
OH0103408Medicaid
KY64047707Medicaid
OH0816995Medicare PIN
IN200293560 AMedicaid