Healthcare Provider Details

I. General information

NPI: 1376736553
Provider Name (Legal Business Name): ELNAZ NASSEHZADEH TABRIZI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1918 RANDOLPH RD STE 600
CHARLOTTE NC
28207-1198
US

IV. Provider business mailing address

801 E MOREHEAD ST STE 100
CHARLOTTE NC
28202-3195
US

V. Phone/Fax

Practice location:
  • Phone: 704-342-0252
  • Fax: 980-533-7801
Mailing address:
  • Phone: 704-342-0252
  • Fax: 980-533-7801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number2011-01299
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: