Healthcare Provider Details

I. General information

NPI: 1134339104
Provider Name (Legal Business Name): SAEED PAYVAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

694 RIVERSIDE DR
MOUNT AIRY NC
27030-3117
US

IV. Provider business mailing address

PO BOX 602362
CHARLOTTE NC
28260-2362
US

V. Phone/Fax

Practice location:
  • Phone: 336-719-7892
  • Fax: 336-719-7898
Mailing address:
  • Phone: 336-719-7892
  • Fax: 336-719-7898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberM-13339
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2011-01682
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: