MEDICARE: JAVAD ABDOLLAHIAN MD, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	MD029443L	PA
2	207R00000X	Internal Medicine Physician	MD029443L	PA

General Provider Information

NPI Number	:	1093995672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAVAD ABDOLLAHIAN MD, PC

Provider Business Mailing Address
First Line	:	1411 HARRISON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124-5932
Country	:	US
Telephone Number	:	215-289-8832
Fax Number	:	215-289-3497

Provider Business Practice Location Address
First Line	:	1411 HARRISON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124-5932
Country	:	US
Telephone Number	:	215-289-8832
Fax Number	:	215-289-3497

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	JAVAD ABDOLLAHIAN
Credential	:
Telephone Number	:	215-289-8832

Provider Enumeration Date	:	11/12/2007
Last Update Date	:	11/16/2007

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