Healthcare Provider Details

I. General information

NPI: 1114657962
Provider Name (Legal Business Name): SAHAR EFTEKHARZADEH MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 OLD YORK RD STE 1
PHILADELPHIA PA
19141-3098
US

IV. Provider business mailing address

5501 OLD YORK RD STE 1
PHILADELPHIA PA
19141-3098
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-3443
  • Fax: 215-456-7792
Mailing address:
  • Phone: 215-456-3443
  • Fax: 215-456-7792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMT225039
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: