Provider Demographics
NPI:1134162464
Name:AZIZI, GHOBAD (MD)
Entity type:Individual
Prefix:DR
First Name:GHOBAD
Middle Name:
Last Name:AZIZI
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 3788
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28406-0788
Mailing Address - Country:US
Mailing Address - Phone:910-254-9464
Mailing Address - Fax:910-254-3474
Practice Address - Street 1:1001 MILITARY CUTOFF RD STE 200
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-4318
Practice Address - Country:US
Practice Address - Phone:910-254-9464
Practice Address - Fax:910-254-3474
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000712207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89126WMMedicaid
NC126WMOtherBLUE CROSS BLUE SHIELD
NC2280563AMedicare ID - Type Unspecified
NC126WMOtherBLUE CROSS BLUE SHIELD