Provider Demographics
NPI:1932156056
Name:HEJAZI, MASOUD S (MD)
Entity Type:Individual
Prefix:DR
First Name:MASOUD
Middle Name:S
Last Name:HEJAZI
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 1:705 PINEY FOREST RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-2860
Mailing Address - Country:US
Mailing Address - Phone:434-710-4210
Mailing Address - Fax:434-792-1471
Practice Address - Street 1:705 PINEY FOREST RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-2860
Practice Address - Country:US
Practice Address - Phone:434-710-4210
Practice Address - Fax:434-792-1471
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010532862084P0802X
NC330632084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8941181Medicaid
NC2313676Medicare ID - Type UnspecifiedMEDICARE
NCC65088Medicare UPIN