Healthcare Provider Details

I. General information

NPI: 1528296415
Provider Name (Legal Business Name): ABIN BANDYOPADHYAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 HIGHLAND AVE SUITE 130
BETHLEHEM PA
18017-9424
US

IV. Provider business mailing address

95 HIGHLAND AVE SUITE 130
BETHLEHEM PA
18017-9424
US

V. Phone/Fax

Practice location:
  • Phone: 610-868-1100
  • Fax: 610-868-1111
Mailing address:
  • Phone: 610-868-1100
  • Fax: 610-868-1111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberMD457776
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMT194459
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: