Individual
FARZAD NOUROLLAH-ZADEH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3400 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-5127
(267) 307-3827
Mailing address
105 S 41ST ST, PHILADELPHIA, PA 19104-3018
(267) 366-9949
Taxonomy
Speciality
Code
Description
License number
State
125Q00000X
Oral Medicine Dentistry
Primary
23-1352685
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
23-1352685
—
PA
05
—
45862287
—
PA
Enumeration date
09/13/2020
Last updated
09/13/2020
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