Healthcare Provider Details

I. General information

NPI: 1639001621
Provider Name (Legal Business Name): MAHYAR TAHBAZ, DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 CORBETT ST STE 250
BELLEAIR FL
33756-7310
US

IV. Provider business mailing address

601 AVERY ST STE 501
PARKERSBURG WV
26101-5192
US

V. Phone/Fax

Practice location:
  • Phone: 304-917-1357
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MAHYAR TAHBAZ
Title or Position: OWNER
Credential: DO
Phone: 304-482-7887