Provider Demographics
NPI:1528069762
Name:ARAGHI, SASAN (MD)
Entity type:Individual
Prefix:
First Name:SASAN
Middle Name:
Last Name:ARAGHI
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 1:116 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-7604
Mailing Address - Country:US
Mailing Address - Phone:910-488-0157
Mailing Address - Fax:910-488-0293
Practice Address - Street 1:116 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-7604
Practice Address - Country:US
Practice Address - Phone:910-488-0157
Practice Address - Fax:910-488-0293
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400794207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC194690OtherMEDCOST
NC89137X3Medicaid
NCI17626Medicare UPIN
NC2033194Medicare ID - Type UnspecifiedPROVIDER NUMBER
NC2033194AMedicare ID - Type UnspecifiedPROVIDER NUMBER
NC89137X3Medicaid