Provider Demographics
NPI:1912759911
Name:TADI, PEYMAN
Entity Type:Individual
Prefix:
First Name:PEYMAN
Middle Name:
Last Name:TADI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 GRIDER ST., ERIE COUNTY MEDICAL CENTER
Mailing Address - Street 2:DEPARTMENT OF DENTISTRY SUIT 150
Mailing Address - City:BUFFLO
Mailing Address - State:NY
Mailing Address - Zip Code:14215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:462 GRIDER ST., ERIE COUNTY MEDICAL CENTER
Practice Address - Street 2:DEPARTMENT OF DENTISTRY SUIT 150
Practice Address - City:BUFFLO
Practice Address - State:NY
Practice Address - Zip Code:14215
Practice Address - Country:US
Practice Address - Phone:716-898-3198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program