Provider Demographics
NPI:1891039707
Name:PEDRAM TAHER M.D.
Entity Type:Organization
Organization Name:PEDRAM TAHER M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TAHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-304-2190
Mailing Address - Street 1:4133 MOHR AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-4750
Mailing Address - Country:US
Mailing Address - Phone:925-425-0932
Mailing Address - Fax:925-600-8068
Practice Address - Street 1:4133 MOHR AVE STE A
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-4750
Practice Address - Country:US
Practice Address - Phone:925-425-0932
Practice Address - Fax:925-600-8068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105998261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center