MEDICARE: DR. MOHAMMAD REZA GHAZI-MOGHADAM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	132638	NY

General Provider Information

NPI Number	:	1023183746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMMAD REZA GHAZI-MOGHADAM M.D.

Provider Business Mailing Address
First Line	:	425 GUY PARK AVE
Second Line	:	SUITE 203
City	:	AMSTERDAM
State	:	NY
Zip	:	12010-1043
Country	:	US
Telephone Number	:	518-843-1449
Fax Number	:	518-843-8215

Provider Business Practice Location Address
First Line	:	425 GUY PARK AVE
Second Line	:	SUITE 203
City	:	AMSTERDAM
State	:	NY
Zip	:	12010-1043
Country	:	US
Telephone Number	:	518-843-1449
Fax Number	:	518-843-8215

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	07/08/2007

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