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General NPI Number Information
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NPI Number | 1013203462
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Entity Type | Individual
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Provider Name | SARA MOGHADDAM M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/23/2011
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Last Update Date | 11/29/2023
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Provider Practice Location Address
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Address Line | 39394 DUPONT BLVD
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City | SELBYVILLE
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State | DE
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Zip | 19175-3040
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Country | US
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Telephone | 302-564-0001
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Fax | 302-436-6328
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Provider Business Mailing Address
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Address Line | 38394 DUPONT BLVD UNIT F&G
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City | SELBYVILLE
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State | DE
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Zip | 19975-3049
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Country | US
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Telephone | 302-564-0001
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | C1-0011369
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License Number State | DE
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