Provider Demographics
NPI:1093995672
Name:JAVAD ABDOLLAHIAN MD, PC
Entity Type:Organization
Organization Name:JAVAD ABDOLLAHIAN MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAVAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDOLLAHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-289-8832
Mailing Address - Street 1:1411 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-5932
Mailing Address - Country:US
Mailing Address - Phone:215-289-8832
Mailing Address - Fax:215-289-3497
Practice Address - Street 1:1411 HARRISON ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-5932
Practice Address - Country:US
Practice Address - Phone:215-289-8832
Practice Address - Fax:215-289-3497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029443L207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB32850Medicare UPIN