Provider Demographics
NPI:1013086560
Name:MOOSAVY, AZITA RAVANBAKHSH (MD)
Entity Type:Individual
Prefix:DR
First Name:AZITA
Middle Name:RAVANBAKHSH
Last Name:MOOSAVY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AZITA
Other - Middle Name:
Other - Last Name:RAVANBAKHSH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:33 WESTWOOD BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707
Mailing Address - Country:US
Mailing Address - Phone:302-352-1719
Mailing Address - Fax:
Practice Address - Street 1:266 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-5235
Practice Address - Country:US
Practice Address - Phone:302-368-2563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0008173174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEC1-0008173OtherMEDICAL LICENSE
DEMD5235OtherDEA
DEG02723I06Medicare PIN
DEMD5235OtherDEA