Provider Demographics
NPI:1922004019
Name:RADFAR, NEZAM (MD)
Entity Type:Individual
Prefix:DR
First Name:NEZAM
Middle Name:
Last Name:RADFAR
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 1:730 BROOKLINE BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15226-2102
Mailing Address - Country:US
Mailing Address - Phone:412-207-8874
Mailing Address - Fax:412-892-9404
Practice Address - Street 1:730 BROOKLINE BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15226-2102
Practice Address - Country:US
Practice Address - Phone:412-207-8874
Practice Address - Fax:412-892-9404
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017837E2080P0205X
PAMD017873E207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006181060001Medicaid
PAC29108Medicare UPIN
PA0006181060001Medicaid