Provider Demographics
NPI:1841450269
Name:FATEMI, DELARAM (MD)
Entity type:Individual
Prefix:DR
First Name:DELARAM
Middle Name:
Last Name:FATEMI
Suffix:
Gender:F
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:PO BOX 741087
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1087
Mailing Address - Country:US
Mailing Address - Phone:727-341-4874
Mailing Address - Fax:727-341-4925
Practice Address - Street 1:6500 38TH AVE N
Practice Address - Street 2:PATHOLOGY DEPT
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1629
Practice Address - Country:US
Practice Address - Phone:727-341-4874
Practice Address - Fax:727-341-4925
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA59151207ZP0102X
FLME125772207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000562010Medicaid
GA202I221907Medicare PIN