Provider Demographics
NPI:1972712388
Name:TOURSAVADKOHI, SHAHAB A (MD)
Entity Type:Individual
Prefix:
First Name:SHAHAB
Middle Name:A
Last Name:TOURSAVADKOHI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:306 W REDWOOD ST FL 4
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1708
Mailing Address - Country:US
Mailing Address - Phone:667-214-1720
Mailing Address - Fax:410-706-6976
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-5840
Practice Address - Fax:410-328-0717
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2020-09-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301088968208600000X
PATMD0047482086S0129X
MDD730082086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery