| Doctor Name: | NIMA MOGHADDAS |
| NPI Number: | 1376625426 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DPM |
| License Number: | POD1001 |
| Business Practice Address: | 37 Palmer St Suite 3 Calais, ME - 046191305 |
| Business Phone Number: | 2074548195 |
| Business Fax Number: | 2074543840 |
| Mailing Address: | 37 Palmer St, Suite 3 CALAIS |
| State: | ME |
| Postal Code: | 046191305 |
| Phone Number: | 2074548195 |
| Fax Number: | 2074543840 |
| NPI Enumeration Date: | 10/19/2006 |
| NPI Last Update Date: | 07/08/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213EP1101X |
| License Number: | POD1001 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ME |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Primary Podiatric Medicine |
| Taxonomy Definition: | |