Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 0101034804 | VA |
NPI | 1003923665 |
---|---|
Provider Name | Massoum Moayery |
First Address | Virginia Beach, VA 23455 |
Second Address | Virginia Beach, VA 23455 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 13/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006304281 | (05) | VA |
08-00045 | UNITED HEALTHCARE (01) | |
1386878 | CAQH (01) | |
321182 | MAMSI (01) | |
330961 | ANTHEM (01) | VA |
35052 | SENTARA/OPTIMA (01) | VA |
4041932 | AETNA (01) | |
6304281 | VIRGINIA PREMIER (01) | VA |
B06242 | (02) |