Provider Demographics
NPI:1386881910
Name:FRED TEHRANI MD LLC
Entity type:Organization
Organization Name:FRED TEHRANI MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:TEHRANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-624-2303
Mailing Address - Street 1:6521 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19135-2538
Mailing Address - Country:US
Mailing Address - Phone:215-624-2303
Mailing Address - Fax:215-624-2577
Practice Address - Street 1:6521 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135-2538
Practice Address - Country:US
Practice Address - Phone:215-624-2303
Practice Address - Fax:215-624-2577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-20
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022630210001Medicaid
PA1022630210001Medicaid