Basic Information
| Provider Information | |||||||||
| NPI: | 1417485079 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GHOBADI | ||||||||
| FirstName: | TELKA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 534 86TH AVENUE | ||||||||
| Address2: | |||||||||
| City: | LAVAL | ||||||||
| State: | QC | ||||||||
| PostalCode: | H7W3A9 | ||||||||
| CountryCode: | CA | ||||||||
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| Practice Location | |||||||||
| Address1: | 8423 MARKET ST. | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | BOARDMAN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307298757 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2017 | ||||||||
| LastUpdateDate: | 10/25/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 57030239 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.