Provider Demographics
NPI:1710294954
Name:KALANTARPOUR, FATEMEH (MD)
Entity Type:Individual
Prefix:
First Name:FATEMEH
Middle Name:
Last Name:KALANTARPOUR
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 1:5405 MCFALL COURT
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-3437
Mailing Address - Country:US
Mailing Address - Phone:804-308-2914
Mailing Address - Fax:
Practice Address - Street 1:4355 INNSLAKE DR
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6742
Practice Address - Country:US
Practice Address - Phone:804-967-9225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101244265207ZH0000X
KY42118207ZH0000X
FLME 105851207ZH0000X
CAA112897207ZH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology