Active NPI
Pouya Hatam-Ebrahimi, D.M.D.
- Periodontics
- Blue Bell, PA
National Provider Identifier
1043498306
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- DS-029503-L
- Practice address
- 676 Dekalb Pike
Suite #207
Blue Bell, PA 19422-1223 - Phone
- (610) 272-4482
- Fax
- (610) 272-4484
- NPI assigned
- Feb 8, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | DS-029503-L | PA | Primary |
Addresses
Primary practice location
676 Dekalb Pike
Suite #207
Blue Bell, PA 19422-1223
Mailing address
676 Dekalb Pike
Suite #207
Blue Bell, PA 19422-1223
Phone (610) 272-4482
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS-029503-L | PA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202428800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202428800000",
"number": "1043498306",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "676 DEKALB PIKE",
"address_2": "SUITE #207",
"city": "BLUE BELL",
"state": "PA",
"postal_code": "194221223",
"telephone_number": "610-272-4482",
"fax_number": "610-272-4484"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "676 DEKALB PIKE",
"address_2": "SUITE #207",
"city": "BLUE BELL",
"state": "PA",
"postal_code": "194221223",
"telephone_number": "610-272-4482",
"fax_number": "610-272-4484"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HATAM-EBRAHIMI",
"first_name": "POUYA",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-02-08",
"last_updated": "2008-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "PA",
"license": "DS-029503-L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Blue Bell, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.