Provider Demographics
NPI:1730472531
Name:VAHEDI, MOHSEN H (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHSEN
Middle Name:H
Last Name:VAHEDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2601 HOLME AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2007
Mailing Address - Country:US
Mailing Address - Phone:267-350-7417
Mailing Address - Fax:215-335-6303
Practice Address - Street 1:1648 HUNTINGDON PIKE
Practice Address - Street 2:
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8001
Practice Address - Country:US
Practice Address - Phone:215-947-3000
Practice Address - Fax:215-938-3829
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049668L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02176974Medicaid
PA001606137Medicaid
PA222156Medicare PIN
PA222456N8SMedicare PIN