Provider Demographics
NPI:1740632843
Name:MOSTAFAVI TOROGHI, SEYED HESAM (MD)
Entity type:Individual
Prefix:
First Name:SEYED HESAM
Middle Name:
Last Name:MOSTAFAVI TOROGHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:S
Other - Middle Name:
Other - Last Name:M TOROGHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2500 MARYLAND RD STE 400
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1225
Mailing Address - Country:US
Mailing Address - Phone:154-814-1432
Mailing Address - Fax:215-481-6790
Practice Address - Street 1:1200 OLD YORK RD DEPT OF
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3720
Practice Address - Country:US
Practice Address - Phone:215-481-2222
Practice Address - Fax:215-481-4361
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT211695390200000X
PAMD468301207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103322593Medicaid
PAMT211695OtherSTATE LICENSE ID