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General NPI Number Information
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NPI Number | 1073917076
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Entity Type | Organization
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Legal Business Name | ABDOLLAH IRAVANI MD PA
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Dates
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Enumeration Date | 10/20/2014
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Last Update Date | 10/20/2014
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Provider Practice Location Address
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Address Line | 2106 N ORANGE AVE # 100
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City | ORLANDO
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State | FL
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Zip | 32804-5535
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Country | US
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Telephone | 407-898-2811
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Fax | 321-316-4713
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Provider Business Mailing Address
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Address Line | 225 W HIGHWAY 434 STE 204
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City | LONGWOOD
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State | FL
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Zip | 32750-4980
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Country | US
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Telephone | 407-898-2811
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Fax | 321-316-4713
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Authorized Official
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Title or Position | MD
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Name | ABDOLLAH IRAVANI
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Credential | MD
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Telephone | 407-898-2811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME31538
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License Number State | FL
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