Healthcare Provider Details

I. General information

NPI: 1003991472
Provider Name (Legal Business Name): ZIAOLLAH HASHEMI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 N HOWE ST
SOUTHPORT NC
28461-3038
US

IV. Provider business mailing address

10251 CROFT POINT LN
LELAND NC
28451-9210
US

V. Phone/Fax

Practice location:
  • Phone: 910-457-3925
  • Fax:
Mailing address:
  • Phone: 910-371-1939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number39610
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: