Provider Demographics
NPI:1215994413
Name:SHARIAT, IRAJ (MD)
Entity type:Individual
Prefix:DR
First Name:IRAJ
Middle Name:
Last Name:SHARIAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 W PATRIOT ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-2044
Mailing Address - Country:US
Mailing Address - Phone:814-443-1489
Mailing Address - Fax:814-443-1385
Practice Address - Street 1:107 W PATRIOT ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-2044
Practice Address - Country:US
Practice Address - Phone:814-443-1489
Practice Address - Fax:814-443-1385
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039116L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASH416641OtherHIGHMARK BC BS
PA0008495060002Medicaid
PA0008495060002Medicaid
PASH416641OtherHIGHMARK BC BS