Provider Demographics
NPI:1477940880
Name:RASHIDIPOUR, OMID (MD)
Entity Type:Individual
Prefix:MR
First Name:OMID
Middle Name:
Last Name:RASHIDIPOUR
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:ONE GUSTAVE LEVY PLACE, BOX 1194
Mailing Address - Street 2:ANNENBERG BUILDING, ROOM 15-75
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029
Mailing Address - Country:US
Mailing Address - Phone:212-241-8465
Mailing Address - Fax:646-537-9681
Practice Address - Street 1:ONE GUSTAVE LEVY PLACE
Practice Address - Street 2:ANNENBERG BUILDING, ROOM 15-75
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-241-8465
Practice Address - Fax:646-537-9681
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-23
Last Update Date:2021-12-07
Deactivation Date:2015-11-06
Deactivation Code:
Reactivation Date:2021-09-30
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY311584207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program