Provider Demographics
NPI:1639433220
Name:ROHANIZADEGAN, MERSEDEH (MD)
Entity Type:Individual
Prefix:
First Name:MERSEDEH
Middle Name:
Last Name:ROHANIZADEGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 SPRUCE ST STE 5100
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4238
Mailing Address - Country:US
Mailing Address - Phone:215-662-4740
Mailing Address - Fax:
Practice Address - Street 1:3400 CIVIC CENTER BLVD.
Practice Address - Street 2:1ST FLR, STE 300S
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4306
Practice Address - Country:US
Practice Address - Phone:215-662-4710
Practice Address - Fax:215-614-0298
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD479123207R00000X, 207SG0201X, 207SG0201X
MA262390207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine