Provider Demographics
NPI:1669155503
Name:ASADOLLAHI, MARJAN
Entity type:Individual
Prefix:
First Name:MARJAN
Middle Name:
Last Name:ASADOLLAHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 CHESTNUT ST APT 608
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5137
Mailing Address - Country:US
Mailing Address - Phone:215-498-6539
Mailing Address - Fax:
Practice Address - Street 1:834 CHESTNUT ST APT 608
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5137
Practice Address - Country:US
Practice Address - Phone:215-498-6539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PALT0009772084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology