Provider Demographics
NPI:1467625541
Name:HEIDAR K. JAHROMI, M.D. P.C.
Entity Type:Organization
Organization Name:HEIDAR K. JAHROMI, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEIDAR
Authorized Official - Middle Name:K
Authorized Official - Last Name:JAHROMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-383-1355
Mailing Address - Street 1:213 REECEVILLE RD
Mailing Address - Street 2:SUITE 22
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-1528
Mailing Address - Country:US
Mailing Address - Phone:610-383-1355
Mailing Address - Fax:610-383-6599
Practice Address - Street 1:213 REECEVILLE RD
Practice Address - Street 2:SUITE 22
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-1528
Practice Address - Country:US
Practice Address - Phone:610-383-1355
Practice Address - Fax:610-383-6599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 017196E2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100639OtherMEDICARE
PA0006004890003Medicaid
PAB36406Medicare UPIN