Healthcare Provider Details

I. General information

NPI: 1629227889
Provider Name (Legal Business Name): BEHROUZ ZAMANIFEKRI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 05/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 COX RD
GASTONIA NC
28054-3453
US

IV. Provider business mailing address

815 COX RD
GASTONIA NC
28054-3453
US

V. Phone/Fax

Practice location:
  • Phone: 704-865-1700
  • Fax: 704-865-7948
Mailing address:
  • Phone: 704-865-1700
  • Fax: 704-865-7948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number5555555
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2013-00660
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: