Provider Demographics
NPI:1164413084
Name:HAMZEH LANGROUDI, MEHRDAD (MD)
Entity Type:Individual
Prefix:
First Name:MEHRDAD
Middle Name:
Last Name:HAMZEH LANGROUDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 FARMINGHAM DRIVE
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080
Mailing Address - Country:US
Mailing Address - Phone:571-777-5102
Mailing Address - Fax:703-563-6256
Practice Address - Street 1:4 FARMINGHAM DRIVE
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080
Practice Address - Country:US
Practice Address - Phone:800-436-4326
Practice Address - Fax:703-563-6256
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08063600207L00000X
VA0101238026207L00000X
PAMD434510207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAI39638Medicare UPIN
NJ110828U0UMedicare PIN