Healthcare Provider Details

I. General information

NPI: 1982863007
Provider Name (Legal Business Name): ASHKON RAZAVI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 N CEDAR CREST BLVD
ALLENTOWN PA
18104
US

IV. Provider business mailing address

3435 WINCHESTER RD
ALLENTOWN PA
18104-2268
US

V. Phone/Fax

Practice location:
  • Phone: 610-861-8080
  • Fax:
Mailing address:
  • Phone: 610-861-8080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberMD449383
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD449383
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberMD449383
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: