Healthcare Provider Details

I. General information

NPI: 1003278664
Provider Name (Legal Business Name): SEPEHR SEDIGH HAGHIGHAT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD
NEWARK DE
19718-2200
US

IV. Provider business mailing address

1020 SANSOM ST STE 239
PHILADELPHIA PA
19107-5002
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-3901
  • Fax:
Mailing address:
  • Phone: 215-955-6844
  • Fax: 215-955-2526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberC1-0013183
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD470206
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: