Healthcare Provider Details

I. General information

NPI: 1003012642
Provider Name (Legal Business Name): NARGES MAZLOOM D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 HIGH POINT BLVD SUITE 400
BETHLEHEM PA
18017-7809
US

IV. Provider business mailing address

3445 HIGH POINT BLVD SUITE 400
BETHLEHEM PA
18017-7809
US

V. Phone/Fax

Practice location:
  • Phone: 610-866-5555
  • Fax: 610-866-3151
Mailing address:
  • Phone: 610-866-5555
  • Fax: 610-866-3151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberOS016026
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: