Provider Demographics
NPI:1285772582
Name:MOUSSAVIAN, SEYED NEMATOLAH (MD)
Entity type:Individual
Prefix:DR
First Name:SEYED
Middle Name:NEMATOLAH
Last Name:MOUSSAVIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-7789
Mailing Address - Country:US
Mailing Address - Phone:513-891-1240
Mailing Address - Fax:513-891-3561
Practice Address - Street 1:9200 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-7789
Practice Address - Country:US
Practice Address - Phone:513-891-1240
Practice Address - Fax:513-891-3561
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20120207RG0100X
OH35-041367174400000X
IN01079427B208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0377211Medicaid
OHMO0443202Medicare ID - Type Unspecified
OHB95403Medicare UPIN