Provider Demographics
NPI:1518217769
Name:PARVEZ FATTEH, MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:PARVEZ FATTEH, MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PARVEZ
Authorized Official - Middle Name:MEHBOOB
Authorized Official - Last Name:FATTEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-742-5795
Mailing Address - Street 1:5820 STONERIDGE MALL RD
Mailing Address - Street 2:#203
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-3274
Mailing Address - Country:US
Mailing Address - Phone:510-742-5795
Mailing Address - Fax:510-742-5799
Practice Address - Street 1:2287 MOWRY AVE
Practice Address - Street 2:STE. H
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1622
Practice Address - Country:US
Practice Address - Phone:510-742-5795
Practice Address - Fax:510-742-5799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66560208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA66560OtherMEDICAL LICENSE
CAH38587Medicare UPIN