1407859929 NPI number — DR. ABDOLAMIR LEHIMGAR ZADEH M.D.

Table of content: SUSAN BACON R.PH (NPI 1245350743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407859929 NPI number — DR. ABDOLAMIR LEHIMGAR ZADEH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZADEH
Provider First Name:
ABDOLAMIR
Provider Middle Name:
LEHIMGAR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1407859929
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4424 CONLIN ST
Provider Second Line Business Mailing Address:
STE 2B
Provider Business Mailing Address City Name:
METAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70006-2147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-888-8717
Provider Business Mailing Address Fax Number:
504-888-8730

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4020 PARIS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHALMETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70043-1362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-277-8423
Provider Business Practice Location Address Fax Number:
504-888-8730
Provider Enumeration Date:
05/30/2005

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: 207RN0300X , with the licence number:  04209R , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4080165 . This is a "AETNA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 76869 . This is a "COVENTRY" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 110043311 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1183725 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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