Provider Demographics
NPI:1659371060
Name:AHDIEH, HOUMAN (MD)
Entity Type:Individual
Prefix:
First Name:HOUMAN
Middle Name:
Last Name:AHDIEH
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 1:1739 W FAIRMONT ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-3189
Mailing Address - Country:US
Mailing Address - Phone:610-437-4988
Mailing Address - Fax:610-437-4176
Practice Address - Street 1:1739 W FAIRMONT ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-3189
Practice Address - Country:US
Practice Address - Phone:610-437-4988
Practice Address - Fax:610-437-4176
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055726L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017112400001Medicaid
PAF86840Medicare UPIN
PA0412930001Medicare NSC
PA400484HUPMedicare PIN