Provider Demographics
NPI:1942921762
Name:TAVAKKOLI, ARMIN DAVID
Entity Type:Individual
Prefix:
First Name:ARMIN
Middle Name:DAVID
Last Name:TAVAKKOLI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER DRIVE
Mailing Address - Street 2:BORWEL 548E
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-2901
Mailing Address - Country:US
Mailing Address - Phone:917-691-5956
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:917-691-5956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-09
Last Update Date:2023-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program