Provider Demographics
NPI:1033753256
Name:HATAM, BEHNAM LEE (CRNP)
Entity Type:Individual
Prefix:
First Name:BEHNAM
Middle Name:LEE
Last Name:HATAM
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 STELLA DR
Mailing Address - Street 2:
Mailing Address - City:TRAFFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15085-1620
Mailing Address - Country:US
Mailing Address - Phone:724-516-4495
Mailing Address - Fax:
Practice Address - Street 1:4727 FRIENDSHIP AVE STE 200
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1778
Practice Address - Country:US
Practice Address - Phone:412-235-5810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020947363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily