Provider Demographics
NPI:1962628222
Name:PASDAR, HOMAYOON (MD)
Entity Type:Individual
Prefix:
First Name:HOMAYOON
Middle Name:
Last Name:PASDAR
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 1:2100 KEYSTONE AVENUE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026
Mailing Address - Country:US
Mailing Address - Phone:610-259-8585
Mailing Address - Fax:610-259-3679
Practice Address - Street 1:2100 KEYSTONE AVENUE
Practice Address - Street 2:SUITE 400
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026
Practice Address - Country:US
Practice Address - Phone:610-259-8585
Practice Address - Fax:610-259-3679
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030384L208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000643181001Medicaid
039389Medicare ID - Type Unspecified
PA000643181001Medicaid