Healthcare Provider Details

I. General information

NPI: 1881120285
Provider Name (Legal Business Name): CIROUS SADEGHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 STARTONSBURG RD
GREENVILLE NC
27834
US

IV. Provider business mailing address

1101 KATIE LANE
GREENVILLE NC
27834
US

V. Phone/Fax

Practice location:
  • Phone: 252-847-4100
  • Fax: 716-898-3279
Mailing address:
  • Phone: 716-525-5478
  • Fax: 716-898-3279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number2024-00588
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: