MEDICARE: DR. MANDANA FARHADIEH MORALES MD, PC

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	2080A0000X	Pediatric Adolescent Medicine Physician	036103258	IL
2	208000000X	Pediatrics Physician	02000068	NC
3	208000000X	Pediatrics Physician	85692	WI
4	208000000X	Pediatrics Physician	MD83399	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740274869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANDANA FARHADIEH MORALES MD, PC

Provider Business Mailing Address
First Line	:	6401 STARGAZE LN STE 106
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-0802
Country	:	US
Telephone Number	:	704-591-7196
Fax Number	:	847-548-9909

Provider Business Practice Location Address
First Line	:	6401 STARGAZE LN STE 106
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-0802
Country	:	US
Telephone Number	:	704-591-7196
Fax Number	:	704-464-1818

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

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	01/20/2026

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