Provider Demographics
NPI:1922058411
Name:GOLZARIAN, JAVAD (MD)
Entity Type:Individual
Prefix:
First Name:JAVAD
Middle Name:
Last Name:GOLZARIAN
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 1:115 MANNING DR SW
Mailing Address - Street 2:SUITE D101
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4341
Mailing Address - Country:US
Mailing Address - Phone:256-533-6070
Mailing Address - Fax:256-533-9374
Practice Address - Street 1:115 MANNING DR SW
Practice Address - Street 2:SUITE D101
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4341
Practice Address - Country:US
Practice Address - Phone:256-533-6070
Practice Address - Fax:256-533-9374
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00022613208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000008573Medicaid
08573Medicare ID - Type Unspecified
G93436Medicare UPIN