Basic Information
| Provider Information | |||||||||
| NPI: | 1770583031 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAHBAZ | ||||||||
| FirstName: | MAHYAR | ||||||||
| MiddleName: | |||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 AVERY ST STE 501 | ||||||||
| Address2: | |||||||||
| City: | PARKERSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 261015192 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044223904 | ||||||||
| FaxNumber: | 3044854466 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 MATTHEW ST | ||||||||
| Address2: | STE 207 | ||||||||
| City: | MARIETTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457501644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044226304 | ||||||||
| FaxNumber: | 3044854466 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2005 | ||||||||
| LastUpdateDate: | 08/29/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 03/21/2006 | ||||||||
| NPIReactivationDate: | 04/07/2006 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 34007944T | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 1956 | WV | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | 1956 | WV | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | 34007944T | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.