Provider Demographics
NPI:1710217674
Name:TAHVILDARI, FAHIMEH HANACHI (MD)
Entity Type:Individual
Prefix:
First Name:FAHIMEH
Middle Name:HANACHI
Last Name:TAHVILDARI
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 1:6736 PIKES LN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4274
Mailing Address - Country:US
Mailing Address - Phone:225-767-6615
Mailing Address - Fax:
Practice Address - Street 1:6736 PIKES LN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4274
Practice Address - Country:US
Practice Address - Phone:225-767-6615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.3871R207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology