MEDICARE: DR. HORMAZDIAR DARA DASTOOR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	00394	MP

General Provider Information

NPI Number	:	1396765806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HORMAZDIAR DARA DASTOOR M.D.

Provider Business Mailing Address
First Line	:	PO BOX 500409
Second Line	:
City	:	SAIPAN
State	:	MP
Zip	:	96950-0409
Country	:	US
Telephone Number	:	670-323-0188
Fax Number	:

Provider Business Practice Location Address
First Line	:	23 NAVY HILL RAD
Second Line	:
City	:	SAIPAN
State	:	MP
Zip	:	96950-0409
Country	:	US
Telephone Number	:	670-323-0188
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	07/08/2007

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