Basic Information
| Provider Information | |||||||||
| NPI: | 1376594150 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOOSAVY | ||||||||
| FirstName: | FARID | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4745 OGLETOWN STANTON RD | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197132067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026237600 | ||||||||
| FaxNumber: | 3023661240 | ||||||||
| Practice Location | |||||||||
| Address1: | 4745 OGLETOWN STANTON RD | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197132067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026237600 | ||||||||
| FaxNumber: | 3023661240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 11/04/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | C10007769 | DE | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 1108627 | 01 | AETNA/USHC | OTHER | 2690976000 | 01 | AMERIHEALTH/KEYSTONE | OTHER | 411415 | 01 | COVENTRY | OTHER | 9855585 | 01 | CIGNA | OTHER | 1000038313 | 05 | DE | MEDICAID | 2690976000 | 01 | INDEPENDENCE BCBS | OTHER | 64767501 | 01 | MD | CAREFIRST BCBS | OTHER |