Provider Demographics
NPI:1992781439
Name:GOODARZI, BIJAN (MD)
Entity type:Individual
Prefix:DR
First Name:BIJAN
Middle Name:
Last Name:GOODARZI
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 1:860 BETHESDA DR
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1800
Mailing Address - Country:US
Mailing Address - Phone:740-454-4651
Mailing Address - Fax:740-454-4653
Practice Address - Street 1:975 BETHESDA DR
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-7500
Practice Address - Country:US
Practice Address - Phone:740-454-6808
Practice Address - Fax:740-454-2236
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052540207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311413469039OtherCARESOURCE PIN
CA1586OtherGROUP MEDICARE RAILROAD
OH000000185164OtherANTHEM PIN
GO0640462OtherMEDICARE PTAN
OH0655778Medicaid
OH000000177088OtherUNISON PIN
OH0700191OtherUHC PIN
OH0989499OtherGROUP MEDICAID
OH160051600OtherMEDICARE RAILROAD
OH160051600OtherMEDICARE RAILROAD
0640464Medicare PIN
E29701Medicare UPIN
CA1586OtherGROUP MEDICARE RAILROAD