Healthcare Provider Details

I. General information

NPI: 1548609506
Provider Name (Legal Business Name): BAHAR SADJADI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2013
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N 15TH ST MAIL STOP 427
PHILADELPHIA PA
19102-1101
US

IV. Provider business mailing address

2100 WALNUT ST APARTMENT 6I
PHILADELPHIA PA
19103-4810
US

V. Phone/Fax

Practice location:
  • Phone: 215-762-7698
  • Fax:
Mailing address:
  • Phone: 510-918-7447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD458853
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: