Provider Demographics
NPI:1619102951
Name:BAGHERPOUR, ARVIN N (MD)
Entity Type:Individual
Prefix:
First Name:ARVIN
Middle Name:N
Last Name:BAGHERPOUR
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 1:10835 N 25TH AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4751
Mailing Address - Country:US
Mailing Address - Phone:602-246-2584
Mailing Address - Fax:602-246-2566
Practice Address - Street 1:10835 N 25TH AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4751
Practice Address - Country:US
Practice Address - Phone:602-246-2584
Practice Address - Fax:602-246-2566
Is Sole Proprietor?:No
Enumeration Date:2009-05-15
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE286272085R0204X, 2085R0202X
IA427142085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1619102951Medicaid
NE09958008Medicare PIN
IAI14677006Medicare PIN