Healthcare Provider Details

I. General information

NPI: 1013203462
Provider Name (Legal Business Name): SARA MOGHADDAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39394 DUPONT BLVD
SELBYVILLE DE
19175-3040
US

IV. Provider business mailing address

38394 DUPONT BLVD UNIT F&G
SELBYVILLE DE
19975-3049
US

V. Phone/Fax

Practice location:
  • Phone: 302-564-0001
  • Fax: 302-436-6328
Mailing address:
  • Phone: 302-564-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberC1-0011369
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: