Provider Demographics
NPI:1467842807
Name:RANJBAR TABAR, KIUMARS (MD)
Entity Type:Individual
Prefix:
First Name:KIUMARS
Middle Name:
Last Name:RANJBAR TABAR
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 1:2566 HAYMAKER RD STE 311
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3555
Mailing Address - Country:US
Mailing Address - Phone:412-359-6800
Mailing Address - Fax:412-359-4721
Practice Address - Street 1:2566 HAYMAKER RD STE 311
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3555
Practice Address - Country:US
Practice Address - Phone:412-359-6800
Practice Address - Fax:412-359-4721
Is Sole Proprietor?:No
Enumeration Date:2015-01-23
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD462493208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103356009Medicaid
13621080OtherCAQH