Provider Demographics
NPI:1306832662
Name:RADFAR, SORAYA (MD)
Entity Type:Individual
Prefix:
First Name:SORAYA
Middle Name:
Last Name:RADFAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1847 TILTON DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241-2636
Mailing Address - Country:US
Mailing Address - Phone:412-341-5991
Mailing Address - Fax:412-341-5994
Practice Address - Street 1:20 CEDAR BLVD
Practice Address - Street 2:
Practice Address - City:MT LEBANON
Practice Address - State:PA
Practice Address - Zip Code:15228-1330
Practice Address - Country:US
Practice Address - Phone:412-341-5991
Practice Address - Fax:412-341-5994
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA034142EPA2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1126203Medicaid
PA1126203Medicaid
B42174Medicare UPIN