Provider Demographics
NPI:1164254942
Name:MEHRABAN, BABRAK
Entity type:Individual
Prefix:
First Name:BABRAK
Middle Name:
Last Name:MEHRABAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 MIDDLEWAY PIKE STE A
Mailing Address - Street 2:
Mailing Address - City:INWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:25428-4034
Mailing Address - Country:US
Mailing Address - Phone:681-446-2611
Mailing Address - Fax:
Practice Address - Street 1:912 MIDDLEWAY PIKE STE A
Practice Address - Street 2:
Practice Address - City:INWOOD
Practice Address - State:WV
Practice Address - Zip Code:25428-4034
Practice Address - Country:US
Practice Address - Phone:804-277-6618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver