Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 25MA11097500 | NJ |
N | 207RI0200X | Infectious Disease | MD461213 | PA |
NPI | 1013215854 |
---|---|
Provider Name | Foad I. Abandeh |
First Address | Marlton, NJ 08053-4197 |
Second Address | Mount Laurel, NJ 08054-4111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2011 |
Last Update Date | 21/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013215854 | (05) | VA |
103315220-0001 | (05) | PA |