Provider Demographics
NPI:1750600532
Name:MOFTAKHAR, PARHAM (MD)
Entity type:Individual
Prefix:DR
First Name:PARHAM
Middle Name:
Last Name:MOFTAKHAR
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 1:226 ATHENA CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1567
Mailing Address - Country:US
Mailing Address - Phone:415-933-7860
Mailing Address - Fax:
Practice Address - Street 1:2055 LIMESTONE RD STE 104
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5536
Practice Address - Country:US
Practice Address - Phone:302-933-7860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1124602085R0202X
DEC1-00113662085R0202X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology