1285644062 NPI number — NASROLLAH JAHDI, M.D.

Table of content: (NPI 1285644062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285644062 NPI number — NASROLLAH JAHDI, M.D.

Organization/Personal Information

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

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:
1285644062
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 369
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEWICKLEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15143-0369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-266-7900
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
751 MERCHANT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMBRIDGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15003-2457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-266-7900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JAHDI
Authorized Official First Name:
NASROLLAH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
724-266-7900

Provider Taxonomy Codes

  • 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: "Y" .

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

  • Identifier: 001071983000 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2006322 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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