Provider Demographics
NPI:1003955576
Name:KHOSHNEVIS, PARVIZ (MD)
Entity type:Individual
Prefix:DR
First Name:PARVIZ
Middle Name:
Last Name:KHOSHNEVIS
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 1:921 S LONG DR STE 202
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-4874
Mailing Address - Country:US
Mailing Address - Phone:910-417-3474
Mailing Address - Fax:910-417-3470
Practice Address - Street 1:921 S LONG DR STE 202
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-4874
Practice Address - Country:US
Practice Address - Phone:910-417-3474
Practice Address - Fax:910-417-3470
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28525174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8948925Medicaid
NCC86771Medicare UPIN
NC8948925Medicaid