Provider Demographics
NPI:1851552996
Name:TAFRESHI-DARABI, NADEREH (MD)
Entity Type:Individual
Prefix:
First Name:NADEREH
Middle Name:
Last Name:TAFRESHI-DARABI
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 1:133 CHURCH HILL RD
Mailing Address - Street 2:
Mailing Address - City:MC KEES ROCKS
Mailing Address - State:PA
Mailing Address - Zip Code:15136-3279
Mailing Address - Country:US
Mailing Address - Phone:412-722-1003
Mailing Address - Fax:412-722-1024
Practice Address - Street 1:133 CHURCH HILL RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:MC KEES ROCKS
Practice Address - State:PA
Practice Address - Zip Code:15136-3279
Practice Address - Country:US
Practice Address - Phone:412-722-1003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD444080207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102641948Medicaid
PA228685Medicare PIN