Healthcare Provider Details

I. General information

NPI: 1528054111
Provider Name (Legal Business Name): AHMAD MOEZZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N MAIN ST DAYTON OB-GYN INC
CENTERVILLE OH
45459-4465
US

IV. Provider business mailing address

6227 WOODEN SHOE DR
DAYTON OH
45459-1557
US

V. Phone/Fax

Practice location:
  • Phone: 937-439-7550
  • Fax: 937-439-7552
Mailing address:
  • Phone: 937-439-5226
  • Fax: 937-439-7561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number35046829
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number35046829
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: