Basic Information
| Provider Information | |||||||||
| NPI: | 1467842807 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RANJBAR TABAR | ||||||||
| FirstName: | KIUMARS | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2566 HAYMAKER RD STE 311 | ||||||||
| Address2: | |||||||||
| City: | MONROEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151463555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123596800 | ||||||||
| FaxNumber: | 4123594721 | ||||||||
| Practice Location | |||||||||
| Address1: | 2566 HAYMAKER RD STE 311 | ||||||||
| Address2: | |||||||||
| City: | MONROEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151463555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123596800 | ||||||||
| FaxNumber: | 4123594721 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2015 | ||||||||
| LastUpdateDate: | 10/06/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD462493 | PA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 103356009 | 05 | PA | MEDICAID | 13621080 | 01 | CAQH | OTHER |