MEDICARE: DR. PARVANEH RAVANDOOST 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	207Q00000X	Family Medicine Physician	MD037059-L	PA
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	MD037059-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861538373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PARVANEH RAVANDOOST M.D.

Provider Business Mailing Address
First Line	:	251 E BRINGHURST ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-1719
Country	:	US
Telephone Number	:	215-844-1020
Fax Number	:	215-844-2702

Provider Business Practice Location Address
First Line	:	8125 STENTON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19150-3530
Country	:	US
Telephone Number	:	215-248-7560
Fax Number	:	215-248-7564

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	12/19/2011

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