Basic Information
| Provider Information | |||||||||
| NPI: | 1669448171 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOQEETH | ||||||||
| FirstName: | SYED | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 638196 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452638196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135696780 | ||||||||
| FaxNumber: | 5137898491 | ||||||||
| Practice Location | |||||||||
| Address1: | 619 OAK ST | ||||||||
| Address2: | STE 645 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452061613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135696780 | ||||||||
| FaxNumber: | 5137898491 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2006 | ||||||||
| LastUpdateDate: | 04/10/2013 | ||||||||
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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 | 207R00000X | 35-067595 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0300X | 35-067595 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200293560 A | 05 | IN | MEDICAID | P00004639 | 01 | OH | RR MEDICARE | OTHER | 0103408 | 05 | OH | MEDICAID | 64047707 | 05 | KY | MEDICAID |