MEDICARE: IRAJ REZVANI MD

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	2080P0205X	Pediatric Endocrinology Physician	MD033063L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457349359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRAJ REZVANI MD

Provider Business Mailing Address
First Line	:	ERIE AVE AT FRONT ST
Second Line	:	SCPA ENDOCRINOLOGY
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-1095
Country	:	US
Telephone Number	:	215-427-8822
Fax Number	:	215-427-8830

Provider Business Practice Location Address
First Line	:	ERIE AVE AT FRONT ST
Second Line	:	SCPA ENDOCRINOLOGY
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-1095
Country	:	US
Telephone Number	:	215-427-8822
Fax Number	:	215-427-8830

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	09/27/2007

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Directions to “ IRAJ REZVANI MD” Practice Location

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