Provider Demographics
NPI:1558443903
Name:DANESCHVAR, HOMAYOUN LEON (MD)
Entity Type:Individual
Prefix:
First Name:HOMAYOUN
Middle Name:LEON
Last Name:DANESCHVAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:789 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2526
Mailing Address - Country:US
Mailing Address - Phone:603-742-7222
Mailing Address - Fax:603-740-7441
Practice Address - Street 1:10 MEMBERS WAY
Practice Address - Street 2:STE 300
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-5933
Practice Address - Country:US
Practice Address - Phone:603-742-7222
Practice Address - Fax:603-740-7441
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH12736207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432079299Medicaid
NH30205669Medicaid
NHRE8575Medicare PIN
NHI48315Medicare UPIN