Provider Demographics
NPI:1821244724
Name:AKHAVAN, ARDAVAN (MD,)
Entity Type:Individual
Prefix:DR
First Name:ARDAVAN
Middle Name:
Last Name:AKHAVAN
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 1:525 E 68TH ST
Mailing Address - Street 2:BOX 94, RM F931
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-4870
Mailing Address - Country:US
Mailing Address - Phone:212-746-5361
Mailing Address - Fax:212-746-8149
Practice Address - Street 1:525 E 68TH ST
Practice Address - Street 2:BOX 94, RM F931
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:212-746-5361
Practice Address - Fax:212-746-8149
Is Sole Proprietor?:No
Enumeration Date:2008-08-11
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD602821072088P0231X
MDD00775912088P0231X
NY2540732088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology