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General NPI Number Information
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NPI Number | 1992738983
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Entity Type | Individual
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Provider Name | POUNEH MOFRAD NIKROOZ MD
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Gender | Female
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 16817 MARVIN RD
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City | CHARLOTTE
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State | NC
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Zip | 28277-2196
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Country | US
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Telephone | 704-495-6036
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Fax |
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Provider Business Mailing Address
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Address Line | 5960 FAIRVIEW RD STE 500
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City | CHARLOTTE
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State | NC
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Zip | 28210-3113
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Country | US
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Telephone | 704-918-1934
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 200401552
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 2004-01552
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License Number State | NC
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