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General NPI Number Information
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NPI Number | 1437689478
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Entity Type | Individual
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Provider Name | MEHDI TAVAKOLI DASTJERDI MD
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Gender | Male
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Dates
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Enumeration Date | 06/13/2017
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Last Update Date | 10/27/2022
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Provider Practice Location Address
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Address Line | 2150 PENNSYLVANIA AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20037-3201
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Country | US
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Telephone | 202-741-2800
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Fax | 202-741-2805
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Provider Business Mailing Address
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Address Line | P.O. BOX 830941 MSC# 559
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City | BIRMINGHAM
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State | AL
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Zip | 35283
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Country | US
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Telephone | 205-325-8536
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Fax | 205-325-8270
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | HSE24976
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | L.5059SP
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License Number State | AL
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