Provider Demographics
NPI:1669819132
Name:KARKVANDEIAN, FARZAD HASHEMI (DO)
Entity Type:Individual
Prefix:
First Name:FARZAD
Middle Name:HASHEMI
Last Name:KARKVANDEIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S HENDERSON RD STE 308C
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-4206
Mailing Address - Country:US
Mailing Address - Phone:610-337-3111
Mailing Address - Fax:
Practice Address - Street 1:700 S HENDERSON RD STE 308C
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-4206
Practice Address - Country:US
Practice Address - Phone:610-337-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO3154208D00000X
NY279179208100000X
PAOS018668208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice