Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DS-029820-L | PA |
Y | 213EG0000X | General Practice | DS-029820-L | PA |
NPI | 1003028440 |
---|---|
Provider Name | Dr. Mohammadreza Assadzadeh |
First Address | West Chester, PA 19382-6174 |
Second Address | Paoli, PA 19301-1743 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2007 |
Last Update Date | 08/07/2007 |