Provider Demographics
NPI:1699761353
Name:NIKPARVARFARD, MEHDI
Entity type:Individual
Prefix:
First Name:MEHDI
Middle Name:
Last Name:NIKPARVARFARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1716
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-0716
Mailing Address - Country:US
Mailing Address - Phone:570-208-5571
Mailing Address - Fax:570-208-5548
Practice Address - Street 1:701 E 16TH ST
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-2316
Practice Address - Country:US
Practice Address - Phone:570-208-5571
Practice Address - Fax:570-208-5548
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424252207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2707388Medicaid
PA1010805460001Medicaid
PA1010805460001Medicaid
OH2707388Medicaid
PAI18051Medicare UPIN