Ettefagh, Keivan

Ettefagh, Keivan is an individual health care provider with primary practice located at 2707 Henry St , Greensboro NC 27405. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Ettefagh, Keivan can be contacted via phone (336) 574-4280.

Contact Information

Primary practice address
2707 Henry St Greensboro NC 27405
Phone: (336) 574-4280
Fax: (336) 574-4634
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X MD07109 Rhode Island
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 2018-00348 North Carolina

Profile Details

NPI number 1144227729
LBN Legal business name Ettefagh, Keivan
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 28th, 2005
Last updated May 16th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1144227729 NPPES
Rhode Island MEDICAID 9002176

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