NPIMap

Organization Active NPI

Mehdi a Marvasti MD PC

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Syracuse, NY
National Provider Identifier
1184618225
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
Legal business name
MEHDI A MARVASTI MD PC
Practice address
104 Union Ave
Suite 1008
Syracuse, NY 13203-2761
Phone
(315) 422-4442
Fax
(315) 448-6126
NPI assigned
Sep 6, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mehdi A Marvasti, MDNPI 1053315044
Title
Owner
Phone
(315) 422-4422

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X NU Primary

Addresses

Primary practice location

104 Union Ave
Suite 1008
Syracuse, NY 13203-2761

Mailing address

104 Union Avenue
Suite 1008
Syracuse, NY 13203-2761
Phone (315) 422-4442

Other identifiers 1

IdentifierTypeStateIssuer
02760176MedicaidNY

National Provider Directory

National Provider Directory

Locations

101 Union Ave
Ste 806
Syracuse, NY 13203
Phone (315) 422-2270

104 Union Ave
Ste 1008
Syracuse, NY 13203
Phone (315) 422-4442

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1125964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1184618225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 UNION AVENUE",
            "address_2": "SUITE 1008",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132032761",
            "telephone_number": "315-422-4442",
            "fax_number": "315-448-6126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 UNION AVE",
            "address_2": "SUITE 1008",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132032761",
            "telephone_number": "315-422-4442",
            "fax_number": "315-448-6126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEHDI A MARVASTI MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MARVASTI",
        "authorized_official_first_name": "MEHDI",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "315-422-4422",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02760176",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.