Healthcare Provider Details

I. General information

NPI: 1700917721
Provider Name (Legal Business Name): BEHZAD HEDAYATI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 5TH AVE
MCKEESPORT PA
15132-2422
US

IV. Provider business mailing address

1711 TEAL TRCE
PITTSBURGH PA
15237-3825
US

V. Phone/Fax

Practice location:
  • Phone: 412-664-2640
  • Fax:
Mailing address:
  • Phone: 412-369-6820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD432237
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: