Provider Demographics
NPI:1326338534
Name:SEYEDIAN, MAZIAR (M D)
Entity Type:Individual
Prefix:DR
First Name:MAZIAR
Middle Name:
Last Name:SEYEDIAN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W LANCASTER AVE STE 232
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1756
Mailing Address - Country:US
Mailing Address - Phone:610-647-8000
Mailing Address - Fax:
Practice Address - Street 1:255 W LANCASTER AVE STE 232
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1756
Practice Address - Country:US
Practice Address - Phone:610-647-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-10
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV289022084N0400X, 2084V0102X
KYTP3792084N0400X
PAMD4794932084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1326338534Medicaid
KY7100212120Medicaid