Healthcare Provider Details

I. General information

NPI: 1174616866
Provider Name (Legal Business Name): BETHLEHEM INFECTIOUS DISEASES ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 OSTRUM STREET
BETHLEHEM PA
18015
US

IV. Provider business mailing address

PO BOX 3667
ALLENTOWN PA
18106-0667
US

V. Phone/Fax

Practice location:
  • Phone: 610-954-4000
  • Fax:
Mailing address:
  • Phone: 610-289-2980
  • Fax: 610-289-2990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: THONG P LE
Title or Position: PRESIDENT
Credential: MD
Phone: 610-954-4000