Provider Demographics
NPI:1194754275
Name:NASHATIZADEH, CECILIA ROSE (MD)
Entity type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:ROSE
Last Name:NASHATIZADEH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 ROGERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-0326
Mailing Address - Country:US
Mailing Address - Phone:913-333-2021
Mailing Address - Fax:
Practice Address - Street 1:205 ROGERSVILLE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-0326
Practice Address - Country:US
Practice Address - Phone:913-333-2021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-01571207QA0505X, 208M00000X
NCNONE207Q00000X
MEMD26313207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine