Basic Information
| Provider Information | |||||||||
| NPI: | 1902199474 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABDOLLAHIAN | ||||||||
| FirstName: | DAVOOD | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2190 NORTH LOOP W | ||||||||
| Address2: | STE 250 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770188016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812069020 | ||||||||
| FaxNumber: | 2812069018 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 N WOLFE ST | ||||||||
| Address2: | DEPARTMENT OF RADIOLOGY | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212870005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105028052 | ||||||||
| FaxNumber: | 4105023659 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2011 | ||||||||
| LastUpdateDate: | 06/22/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2085R0202X | R1919 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | D76085 | 01 | MD | MARYLAND STATE LICENSE | OTHER | 11016009A | 01 | IN | INDIANA STATE MEDICAL LICENSING BOARD | OTHER |