Provider Demographics
NPI:1225692676
Name:MOTAMEDI, PEDRAM (MD)
Entity Type:Individual
Prefix:
First Name:PEDRAM
Middle Name:
Last Name:MOTAMEDI
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 1:9201 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2532
Mailing Address - Country:US
Mailing Address - Phone:480-882-4545
Mailing Address - Fax:602-870-6348
Practice Address - Street 1:9201 N 5TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2532
Practice Address - Country:US
Practice Address - Phone:480-882-4545
Practice Address - Fax:602-870-6348
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program