Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | MD034478L | PA |
NPI | 1013972736 |
---|---|
Provider Name | Shahriar Yazdanfar |
First Address | Philadelphia, PA 19178-0001 |
Second Address | Philadelphia, PA 19141 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2006 |
Last Update Date | 21/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000695366 | (05) | PA |
B36809 | (02) |