Provider Demographics
NPI:1619319472
Name:SABER TEHRANI, ALI SHABAHANG (MD)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:SHABAHANG
Last Name:SABER TEHRANI
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 1:600 N. WOLFE STREET, PHIPPS BUILDING,
Mailing Address - Street 2:PHIPPS BUILDING, SUITE 493
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287
Mailing Address - Country:US
Mailing Address - Phone:410-955-2228
Mailing Address - Fax:
Practice Address - Street 1:600 N WOLFE STREET
Practice Address - Street 2:PHIPPS BUILDING, SUITE 793
Practice Address - City:BALITMORE
Practice Address - State:MD
Practice Address - Zip Code:21287
Practice Address - Country:US
Practice Address - Phone:309-655-2702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1250642692084N0400X
MDD00851322084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology