Provider Demographics
NPI:1073917076
Name:ABDOLLAH IRAVANI MD PA
Entity Type:Organization
Organization Name:ABDOLLAH IRAVANI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ABDOLLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:IRAVANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-898-2811
Mailing Address - Street 1:225 W HIGHWAY 434 STE 204
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4980
Mailing Address - Country:US
Mailing Address - Phone:407-898-2811
Mailing Address - Fax:321-316-4713
Practice Address - Street 1:2106 N ORANGE AVE # 100
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5535
Practice Address - Country:US
Practice Address - Phone:407-898-2811
Practice Address - Fax:321-316-4713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME31538208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty