Provider Demographics
NPI:1144386665
Name:TAVAKOLI, DONALD N (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:N
Last Name:TAVAKOLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:191 PRESIDENTIAL BLVD
Mailing Address - Street 2:SUITE C132
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1207
Mailing Address - Country:US
Mailing Address - Phone:610-664-5182
Mailing Address - Fax:
Practice Address - Street 1:191 PRESIDENTIAL BLVD
Practice Address - Street 2:SUITE C132
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1207
Practice Address - Country:US
Practice Address - Phone:610-664-5182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD4321542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry