Provider Demographics
NPI:1407352677
Name:MOVASSAGHI, MIYAD (MD)
Entity type:Individual
Prefix:
First Name:MIYAD
Middle Name:
Last Name:MOVASSAGHI
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 1:2606 LAURELCHERRY ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5442
Mailing Address - Country:US
Mailing Address - Phone:607-592-9666
Mailing Address - Fax:
Practice Address - Street 1:3821 ED DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8038
Practice Address - Country:US
Practice Address - Phone:919-758-8677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2024-00254208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology