Healthcare Provider Details

I. General information

NPI: 1285772582
Provider Name (Legal Business Name): SEYED NEMATOLAH MOUSSAVIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 10/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 MONTGOMERY RD
CINCINNATI OH
45242-7789
US

IV. Provider business mailing address

9200 MONTGOMERY RD
CINCINNATI OH
45242-7789
US

V. Phone/Fax

Practice location:
  • Phone: 513-891-1240
  • Fax: 513-891-3561
Mailing address:
  • Phone: 513-891-1240
  • Fax: 513-891-3561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number35-041367
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number20120
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01079427B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: