Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | SC006354 | PA |
Y | 213ES0103X | Foot & Ankle Surgery | SC006354 | PA |
NPI | 1467716092 |
---|---|
Provider Name | Dr. Rodmehr Ajdari |
First Address | Philadelphia, PA 19128-2661 |
Second Address | Philadelphia, PA 19118-2722 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2012 |
Last Update Date | 28/06/2012 |