Provider Demographics
NPI:1255539938
Name:NAMDARI, SURENA (MD)
Entity type:Individual
Prefix:
First Name:SURENA
Middle Name:
Last Name:NAMDARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 CHESTNUT ST STE 520
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4430
Mailing Address - Country:US
Mailing Address - Phone:800-321-9999
Mailing Address - Fax:215-503-0580
Practice Address - Street 1:925 CHESTNUT ST
Practice Address - Street 2:FIFTH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4216
Practice Address - Country:US
Practice Address - Phone:267-339-3500
Practice Address - Fax:215-503-0580
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME152741207X00000X
NY303276207X00000X
NJ25MA09379500207X00000X
MO2012003480207X00000X
PAMD442158207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery