Provider Demographics
NPI:1467671396
Name:KABASAKALIAN, ANAHID (MD)
Entity Type:Individual
Prefix:DR
First Name:ANAHID
Middle Name:
Last Name:KABASAKALIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:101 E OLNEY AVENUE
Mailing Address - Street 2:SUITE 400--PROVIDER ENROLLMENT
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2421
Mailing Address - Country:US
Mailing Address - Phone:215-254-2612
Mailing Address - Fax:
Practice Address - Street 1:5401 OLD YORK ROAD
Practice Address - Street 2:KLEIN BUILDING, SUITE 404
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141
Practice Address - Country:US
Practice Address - Phone:215-456-7190
Practice Address - Fax:215-456-7308
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT1827872084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology