{
"Npi": {
"NPI": "1013203462",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MOGHADDAM",
"FirstName": "SARA",
"MiddleName": null,
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "38394 DUPONT BLVD UNIT F&G",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SELBYVILLE",
"MailingAddressStateName": "DE",
"MailingAddressPostalCode": "19975-3049",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "302-564-0001",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "39394 DUPONT BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SELBYVILLE",
"PracticeLocationAddressStateName": "DE",
"PracticeLocationAddressPostalCode": "19175-3040",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "302-564-0001",
"PracticeLocationAddressFaxNumber": "302-436-6328",
"EnumerationDate": "06/23/2011",
"LastUpdateDate": "11/29/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207N00000X",
"TaxonomyName": "Dermatology Physician",
"LicenseNumber": "C1-0011369",
"LicenseNumberStateCode": "DE",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}