Healthcare Provider Details

I. General information

NPI: 1588358683
Provider Name (Legal Business Name): HASSAN KHOJASTEH JAFARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 STATE ST STE 201
ERIE PA
16507-1429
US

IV. Provider business mailing address

5845 BLUESTONE DR
FAIRVIEW PA
16415-2545
US

V. Phone/Fax

Practice location:
  • Phone: 305-326-6391
  • Fax:
Mailing address:
  • Phone: 65-078-9176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberMD489419
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: