Abbas Mahdavi MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A313250 Issued in CA

Legal business name

ABBAS MAHDAVI MD

Practice address

3903 Lone Tree Way
211
Antioch, CA 94509

Phone

(925) 754-7200

Fax

(925) 754-7290

NPI assigned

Jan 31, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Abbas Mahdavi, MD

Title

Owner

Phone

(925) 754-7200

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Delta Pediatrics Inc Doing business as

Tax ID family

Abbas Mahdavi MD Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Abbas Mahdavi MD Inc

  • Pediatrics Physician
  • Antioch, CA
  • NPI 1861800633
  NPD tax ID
• Delta Pediatrics Medical Group, Inc.

  • Preferred Provider Organization
  • Antioch, CA
  • NPI 1750334660
  NPD tax ID

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1992842918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3903 LONE TREE WAY",
            "address_2": "211",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "94509",
            "telephone_number": "925-754-7200",
            "fax_number": "925-754-7290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3903 LONE TREE WAY",
            "address_2": "211",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "94509",
            "telephone_number": "925-754-7200",
            "fax_number": "925-754-7290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABBAS MAHDAVI MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MAHDAVI",
        "authorized_official_first_name": "ABBAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "925-754-7200",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A313250",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCAL",
            "identifier": "6202716",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Delta Pediatrics Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Nayyirah Glori'Ya Abdulsalam
• Judith Abesamis
• Tonia M Abloogalook

• Pediatrics Physician in Antioch, CA
• Providers in Antioch, CA by specialty
• Pediatrics Physician in California

• 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.