National Provider Identifier Database

HOMAYOUN MODARRESIFAR, MD – NPI #1235146648
Nuclear Imaging & Therapy


Contact Information

HOMAYOUN MODARRESIFAR, MD
2109 W MARKET ST STE 122
ETSU, INNOVATION LABORATORY
JOHNSON CITY, TN37604-6024
Phone: 423-439-8000
Fax:
Website:
Specialty Taxonomy Code
* Nuclear Imaging & Therapy 207UN0902X
Nuclear Medicine 207U00000X

* Indicates primary specialty

NPI Profile & details for HOMAYOUN MODARRESIFAR

NPI Number 1235146648
Credentials MD
Entity Individual
Enumeration date 08/01/2006
Last updated 05/13/2011 - About 15 years ago
Sole proprietor1 No
Identifiers
  • AZ License #: 41198
  • CA License #: A93513
  • TN License #: MD0000046850
  • TX License #: N5255
  • TN Other: MD0000046850 TENNESSEE MEDICAL LICENSE
Hospital affiliation n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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