Healthcare Provider Details

I. General information

NPI: 1265852206
Provider Name (Legal Business Name): SARA DEHBASHI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 WALNUT ST FL 4
PHILADELPHIA PA
19107-5211
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL # 1137
NEW YORK NY
10029-6504
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-7952
  • Fax:
Mailing address:
  • Phone: 212-241-1830
  • Fax: 212-987-7635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberBP10050276
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberBP2-0054683
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License NumberBP20054683
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License NumberMD467604
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: