Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | MD033063L | PA |
NPI | 1457349359 |
---|---|
Provider Name | Iraj Rezvani |
First Address | Philadelphia, PA 19134-1095 |
Second Address | Philadelphia, PA 19134-1095 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2005 |
Last Update Date | 27/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0006658770004 | (05) | PA |
B39911 | (02) |