MEDICARE: DR. VIDDA MOUSSAVI SIMPSON MD

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	207V00000X	Obstetrics & Gynecology Physician	0101288953	VA
2	207V00000X	Obstetrics & Gynecology Physician	2024-01858	NC

General Provider Information

NPI Number	:	1801391776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIDDA MOUSSAVI SIMPSON MD

Provider Business Mailing Address
First Line	:	4420 LAKE BOONE TRL
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-7505
Country	:	US
Telephone Number	:	919-784-3100
Fax Number	:

Provider Business Practice Location Address
First Line	:	4420 LAKE BOONE TRL
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-7505
Country	:	US
Telephone Number	:	919-567-6133
Fax Number	:

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

Provider Enumeration Date	:	03/24/2018
Last Update Date	:	06/12/2026

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