1477578136 NPI number — DR. NASROLLAH JAHDI MD

Table of content: DR. NASROLLAH JAHDI MD (NPI 1477578136)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477578136 NPI number — DR. NASROLLAH JAHDI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAHDI
Provider First Name:
NASROLLAH
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477578136
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
380 SUMMIT AVE
Provider Second Line Business Mailing Address:
MSO PHYSICIAN BILLING
Provider Business Mailing Address City Name:
STEUBENVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43952-2667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-283-7597
Provider Business Mailing Address Fax Number:
740-283-7608

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1805 SINCLAIR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STEUBENVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43953-3327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-282-9093
Provider Business Practice Location Address Fax Number:
740-282-9087
Provider Enumeration Date:
07/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  13211 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: MD028222E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: 35.064997 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000653964 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 428359 . This is a "HIGHMARK BC/BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2006322 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810008147 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001071983 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 428359 . This is a "MOUNTAIN STATE BC/BS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".