Provider Demographics
NPI:1598868879
Name:TABATABAI, MAHMOOD (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHMOOD
Middle Name:
Last Name:TABATABAI
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 1:1801 BUTTONWOOD ST
Mailing Address - Street 2:APT # 604
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3945
Mailing Address - Country:US
Mailing Address - Phone:215-981-0182
Mailing Address - Fax:
Practice Address - Street 1:3900 WOODLAND AVENUE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-823-5800
Practice Address - Fax:215-823-4171
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-028729-E207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology