Individual
KHOSROW RASTGAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1925 PACIFIC AVE, ATLANTIC CITY, NJ 08401-6713
(609) 441-2147
(609) 441-2107
Mailing address
PO BOX 95000-2705, PHILADELPHIA, PA 19195-2705
(609) 441-2147
(609) 441-2107
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
25MA03458300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3816206
—
NJ
Enumeration date
07/29/2005
Last updated
06/16/2010
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