MEDICARE: DR. JAVAD TABATABAIAN 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	35035392	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	000000020993	OTHER	ANTHEM
2	0403007	OTHER	UHC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780763938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAVAD TABATABAIAN MD

Provider Business Mailing Address
First Line	:	PO BOX 41056
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45441
Country	:	US
Telephone Number	:	937-277-5367
Fax Number	:	937-277-6919

Provider Business Practice Location Address
First Line	:	2200 PHILADELPHIA DR
Second Line	:	SUITE 544
City	:	DAYTON
State	:	OH
Zip	:	45406-1830
Country	:	US
Telephone Number	:	937-277-5367
Fax Number	:	937-277-6919

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	12/28/2009

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