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General NPI Number Information
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NPI Number | 1417485079
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Entity Type | Individual
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Provider Name | TELKA GHOBADI M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/26/2017
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Last Update Date | 10/25/2017
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Provider Practice Location Address
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Address Line | 8423 MARKET ST. SUITE 101
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City | BOARDMAN
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State | OH
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Zip | 44512
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Country | US
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Telephone | 330-729-8757
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Fax |
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Provider Business Mailing Address
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Address Line | 534 86TH AVENUE
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City | LAVAL
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State | QC
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Zip | H7W3A9
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Country | CA
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 57030239
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License Number State | OH
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