Provider Demographics
NPI:1518166925
Name:ABTAHIAN, FARHAD
Entity Type:Individual
Prefix:
First Name:FARHAD
Middle Name:
Last Name:ABTAHIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 PORTLAND AVENUE
Mailing Address - Street 2:SANDS CONSTELLATION HEART INSTITUTE
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3022
Mailing Address - Country:US
Mailing Address - Phone:585-442-5320
Mailing Address - Fax:585-442-5526
Practice Address - Street 1:1415 PORTLAND AVE
Practice Address - Street 2:SANDS CONSTELLATION HEART INSTITUTE
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3038
Practice Address - Country:US
Practice Address - Phone:585-442-5320
Practice Address - Fax:585-442-5526
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA233006207R00000X
MA242140207RC0000X
NY279306-1207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400233295Medicare PIN
NYJ40023287Medicare PIN