Provider Demographics
NPI:1871674648
Name:NABAVI, ABDOLLAH (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDOLLAH
Middle Name:
Last Name:NABAVI
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 1:315 S ALLEN ST
Mailing Address - Street 2:SUITE 223
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-4849
Mailing Address - Country:US
Mailing Address - Phone:814-237-5411
Mailing Address - Fax:814-237-2656
Practice Address - Street 1:315 S ALLEN ST
Practice Address - Street 2:SUITE 223
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-4849
Practice Address - Country:US
Practice Address - Phone:814-237-5411
Practice Address - Fax:814-237-2656
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038134L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005573140003Medicaid
PA0005573140003Medicaid
PANA91353Medicare ID - Type Unspecified