Provider Demographics
NPI:1912992967
Name:TAROKH, SAEED (MD)
Entity Type:Individual
Prefix:
First Name:SAEED
Middle Name:
Last Name:TAROKH
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 1:512 E SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16354-2049
Mailing Address - Country:US
Mailing Address - Phone:814-827-7170
Mailing Address - Fax:
Practice Address - Street 1:335 W OAK ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16354-1416
Practice Address - Country:US
Practice Address - Phone:814-827-3814
Practice Address - Fax:814-827-6312
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428233207Q00000X
NY244670207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015241320002Medicaid
PA099561GZHMedicare ID - Type Unspecified
PA1015241320002Medicaid