MEDICARE: DR. KAMRAN GOUDARZI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	25503	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972562593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAMRAN GOUDARZI M.D.

Provider Business Mailing Address
First Line	:	710 MILITARY CUTOFF RD STE 130
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28405-2382
Country	:	US
Telephone Number	:	910-769-3084
Fax Number	:	910-769-6023

Provider Business Practice Location Address
First Line	:	710 MILITARY CUTOFF RD STE 130
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28405-2382
Country	:	US
Telephone Number	:	910-769-3084
Fax Number	:	910-769-6023

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	05/13/2020

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