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1780179952

NPI Code Detail

MEDICARE: SEYED HADI MIRHEDAYATI ROUDSARI MD

MEDICARE: SEYED HADI MIRHEDAYATI ROUDSARI 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	207R00000X	Internal Medicine Physician	A194794	CA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207R00000X	Internal Medicine Physician	311981	NY

General Provider Information

NPI Number	:	1780179952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEYED HADI MIRHEDAYATI ROUDSARI MD

Provider Business Mailing Address
First Line	:	4422 3RD AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10457-2594
Country	:	US
Telephone Number	:	718-960-6205
Fax Number	:

Provider Business Practice Location Address
First Line	:	4422 3RD AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10457-2594
Country	:	US
Telephone Number	:	718-960-6205
Fax Number	:

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

Provider Enumeration Date	:	06/28/2018
Last Update Date	:	12/26/2025

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Directions to “ SEYED HADI MIRHEDAYATI ROUDSARI MD” Practice Location

Language	Start Address	Practice Location

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