Provider Demographics
NPI:1003923665
Name:MOAYERY, MASSOUM (MD)
Entity type:Individual
Prefix:
First Name:MASSOUM
Middle Name:
Last Name:MOAYERY
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 1:700 INDEPENDENCE CIRCLE
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455
Mailing Address - Country:US
Mailing Address - Phone:757-497-1987
Mailing Address - Fax:757-671-7002
Practice Address - Street 1:700 INDEPENDENCE CIRCLE
Practice Address - Street 2:SUITE 2D
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455
Practice Address - Country:US
Practice Address - Phone:757-497-1987
Practice Address - Fax:757-671-7002
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034804207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4041932OtherAETNA
1386878OtherCAQH
321182OtherMAMSI
VA6304281OtherVIRGINIA PREMIER
VA35052OtherSENTARA/OPTIMA
VA006304281Medicaid
08-00045OtherUNITED HEALTHCARE
VA330961OtherANTHEM
VA006304281Medicaid
180004044Medicare ID - Type UnspecifiedRAILROAD MEDICARE
VA35052OtherSENTARA/OPTIMA
08-00045OtherUNITED HEALTHCARE