Healthcare Provider Details

I. General information

NPI: 1831136076
Provider Name (Legal Business Name): OMID G MOAYED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 BROADWAY ST
QUINCY IL
62301-2834
US

IV. Provider business mailing address

PO BOX 64793
BALTIMORE MD
21264-4793
US

V. Phone/Fax

Practice location:
  • Phone: 217-223-1200
  • Fax: 217-223-9552
Mailing address:
  • Phone: 410-328-6704
  • Fax: 410-328-4124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036099252
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD59380
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number036099252
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberD59380
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME145213
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: