Provider Demographics
NPI:1770567901
Name:TEHRANI, FEREIDOUN BAKHSH (MD)
Entity type:Individual
Prefix:
First Name:FEREIDOUN
Middle Name:BAKHSH
Last Name:TEHRANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FRED
Other - Middle Name:BAKHSH
Other - Last Name:TEHRANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6521 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19135-2538
Mailing Address - Country:US
Mailing Address - Phone:215-624-2303
Mailing Address - Fax:215-624-2577
Practice Address - Street 1:6521 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19135
Practice Address - Country:US
Practice Address - Phone:215-624-2303
Practice Address - Fax:215-624-2577
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039033L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022630210001Medicaid
PA149813Medicare PIN
PA1022630210001Medicaid