Provider Demographics
NPI:1720028517
Name:HEIDARY, DARIUSH (MD)
Entity type:Individual
Prefix:
First Name:DARIUSH
Middle Name:
Last Name:HEIDARY
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 1:4750 WATERS AVE
Mailing Address - Street 2:SUITE 452
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6200
Mailing Address - Country:US
Mailing Address - Phone:912-354-7188
Mailing Address - Fax:912-354-5208
Practice Address - Street 1:4750 WATERS AVE
Practice Address - Street 2:SUITE 452
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6200
Practice Address - Country:US
Practice Address - Phone:912-354-7188
Practice Address - Fax:912-354-5208
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018668208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC146170Medicaid
P00279274OtherRAILROAD MEDICARE
582162071066OtherCHAMPUS
GA967351OtherBLUE CROSS BLUE SHIELD
GA000133042DMedicaid
SC146170Medicaid
GA000133042DMedicaid