Anzor Modzgvreschvili, RD

Primary specialty

Gerontological Nutrition Registered DietitianTaxonomy code 133VN1101X

License

C05672 Issued in MD

Practice address

15750 Joy Rd
Detroit, MI 48228-2196

Phone

(313) 273-6850

NPI assigned

Mar 15, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cloud Health Medical Group of New Jersey, P.C.

  • Internal Medicine Physician
  • Union City, NJ
  • NPI 1043995467
  NPD (past)
• Cloud Health Medical Group, P.a.

  • Internal Medicine Physician
  • White Plains, NY
  • NPI 1528744935
  NPD (past)
• Nourish, Inc.

  • Registered Dietitian
  • Austin, TX
  • NPI 1558097824
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1584230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663632000000",
    "number": "1245866862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6201 GREENLEIGH AVE",
            "city": "MIDDLE RIVER",
            "state": "MD",
            "postal_code": "212202004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15750 JOY RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482282196",
            "telephone_number": "313-273-6850"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8600 Old Georgetown Rd",
            "address_purpose": "LOCATION",
            "city": "Bethesda",
            "state": "MD",
            "postal_code": "208141422",
            "country_code": "US",
            "telephone_number": "301-896-2578",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MODZGVRESCHVILI",
        "first_name": "ANZOR",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-15",
        "last_updated": "2022-09-20",
        "certification_date": "2022-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1101X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Gerontological",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133VN1101X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Gerontological",
            "state": "MD",
            "license": "C05672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Modern Health Connections LLC
• Dipenkumar Kanaiyalal Modi, M.D.
• Nili Modi, MD
• Joshua Michael Modrick, DO
• Ashish M Mody, M.D.
• Kelsie Marie Moeller, DO
• Kristen Moerchen
• Savannah Rose Moffat
• Kirsten I Mogbo, MD
• Marjan Moghaddam, D.O

• Registered Dietitian in Detroit, MI
• Providers in Detroit, MI by specialty
• Registered Dietitian in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.