Provider Demographics
NPI:1447477112
Name:MOGHBELI, ANOOSHEH (MD)
Entity type:Individual
Prefix:DR
First Name:ANOOSHEH
Middle Name:
Last Name:MOGHBELI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 RICHLAND MEDICAL PARK DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6877
Mailing Address - Country:US
Mailing Address - Phone:803-799-9044
Mailing Address - Fax:803-256-8119
Practice Address - Street 1:14 RICHLAND MEDICAL PARK DR
Practice Address - Street 2:SUITE 410
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6877
Practice Address - Country:US
Practice Address - Phone:803-799-9044
Practice Address - Fax:803-256-8119
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08612600208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
077356 SK3Medicare PIN