Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 297301 | NY |
NPI | 1295184554 |
---|---|
Provider Name | Payam Hadian |
First Address | Gouverneur, NY 13642 |
Second Address | Gouverneur, NY 13642 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2016 |
Last Update Date | 30/07/2019 |