Provider Demographics
NPI:1336248426
Name:PANAHANDEH, ABOLHASSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ABOLHASSAN
Middle Name:
Last Name:PANAHANDEH
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 1:4725 MCKNIGHT RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-3414
Mailing Address - Country:US
Mailing Address - Phone:412-369-8112
Mailing Address - Fax:412-369-8113
Practice Address - Street 1:4725 MCKNIGHT RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-3414
Practice Address - Country:US
Practice Address - Phone:412-369-8112
Practice Address - Fax:412-369-8113
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-031736-L208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPA035803Medicare ID - Type Unspecified
PAD71114Medicare UPIN