Provider Demographics
NPI:1356400410
Name:BEHROOZ, ANOOSHEH (MD)
Entity type:Individual
Prefix:
First Name:ANOOSHEH
Middle Name:
Last Name:BEHROOZ
Suffix:
Gender:F
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 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-7417
Mailing Address - Fax:614-293-5167
Practice Address - Street 1:1800 ZOLLINGER RD FL 5
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2800
Practice Address - Country:US
Practice Address - Phone:614-293-7417
Practice Address - Fax:614-293-5167
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97094207Q00000X
OH35.096326207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3114329Medicaid
OH4309531Medicare PIN