Provider Demographics
NPI:1528054111
Name:MOEZZI, AHMAD (MD)
Entity type:Individual
Prefix:MR
First Name:AHMAD
Middle Name:
Last Name:MOEZZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6227 WOODEN SHOE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-1557
Mailing Address - Country:US
Mailing Address - Phone:937-439-5226
Mailing Address - Fax:937-439-7561
Practice Address - Street 1:330 N MAIN ST
Practice Address - Street 2:DAYTON OB-GYN INC
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4465
Practice Address - Country:US
Practice Address - Phone:937-439-7550
Practice Address - Fax:937-439-7552
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35046829207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Not Answered207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0486808Medicaid
A80189Medicare UPIN
OH0486808Medicaid