Provider Demographics
NPI:1336149897
Name:DAGHESTANI, AIMAN NASSRALLAH (MD)
Entity Type:Individual
Prefix:DR
First Name:AIMAN
Middle Name:NASSRALLAH
Last Name:DAGHESTANI
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 1:247 MOREWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-1861
Mailing Address - Country:US
Mailing Address - Phone:412-622-0290
Mailing Address - Fax:
Practice Address - Street 1:6321 ROUTE 30 STE 300
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-9704
Practice Address - Country:US
Practice Address - Phone:724-671-1800
Practice Address - Fax:724-523-7720
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030033E207RX0202X
IL036056320207R00000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH685003Medicaid
PA000915174Medicaid
PA109325Medicare PIN
PAP00218525Medicare PIN
PA060851NHPMedicare PIN