Provider Demographics
NPI:1346216462
Name:FIRDAUS, TAHIR (MD)
Entity Type:Individual
Prefix:DR
First Name:TAHIR
Middle Name:
Last Name:FIRDAUS
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 1:550 PARMALEE AVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44510-1602
Mailing Address - Country:US
Mailing Address - Phone:133-074-3340
Mailing Address - Fax:133-074-3137
Practice Address - Street 1:550 PARMALEE AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44510-1602
Practice Address - Country:US
Practice Address - Phone:133-074-3340
Practice Address - Fax:133-074-3137
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35039403174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHA75606Medicare UPIN