Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 2006-00260 | NC |
NPI | 1124137716 |
---|---|
Provider Name | Reza Nazemzadeh |
First Address | Charlotte, NC 28219-9305 |
Second Address | Charlotte, NC 28211-4369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 20/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I63950 | (02) | NC |