Provider Demographics
NPI:1346481645
Name:MAHDAVI, RAMYAR (MD)
Entity type:Individual
Prefix:
First Name:RAMYAR
Middle Name:
Last Name:MAHDAVI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3426 RED ROSE DR
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4214
Mailing Address - Country:US
Mailing Address - Phone:818-300-6191
Mailing Address - Fax:
Practice Address - Street 1:1511 W GLENOAKS BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-1912
Practice Address - Country:US
Practice Address - Phone:818-637-2200
Practice Address - Fax:818-637-2250
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI62403-20207RP1001X
CAA109897207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine