Provider Demographics
NPI:1740456920
Name:MOAINIE, NIMA S (MD)
Entity type:Individual
Prefix:DR
First Name:NIMA
Middle Name:S
Last Name:MOAINIE
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 1:4301 CONNECTICUT AVE NW STE 125
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-2332
Mailing Address - Country:US
Mailing Address - Phone:202-362-4545
Mailing Address - Fax:
Practice Address - Street 1:4301 CONNECTICUT AVE NW STE 125
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008
Practice Address - Country:US
Practice Address - Phone:202-362-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD039349207W00000X
MDD0072186207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC059392800Medicaid