# MEHDI A MARVASTI MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184618225
- **Authorized official:** MEHDI A MARVASTI MD (OWNER)
- **Authorized official phone:** (315) 422-4422

## Contact information

- **Practice address:** 104 UNION AVE, SUITE 1008, SYRACUSE, NY 13203-2761
- **Practice address phone:** (315) 422-4442
- **Practice address fax:** (315) 448-6126
- **Mailing address:** 104 UNION AVENUE, SUITE 1008, SYRACUSE, NY 13203-2761
- **Mailing address phone:** (315) 422-4442
- **Mailing address fax:** (315) 448-6126

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/06/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 02760176 | — | NY |