Provider Demographics
NPI:1457945446
Name:PBH PROFESSIONAL GROUP, P.A.
Entity type:Organization
Organization Name:PBH PROFESSIONAL GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:FLORA
Authorized Official - Middle Name:F
Authorized Official - Last Name:SADRI-AZARBAYEJANI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:615-308-7871
Mailing Address - Street 1:103 POWELL CT STE 100
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5050
Mailing Address - Country:US
Mailing Address - Phone:615-308-7871
Mailing Address - Fax:615-261-8901
Practice Address - Street 1:1329 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01603-1548
Practice Address - Country:US
Practice Address - Phone:508-556-2002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty