Basic Information
Provider Information
NPI: 1003806134
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BIGDELI
FirstName: GHAZALEH
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 14130
Address2:  
City: YOUNGSTOWN
State: OH
PostalCode: 445147130
CountryCode: US
TelephoneNumber: 3307587575
FaxNumber:  
Practice Location
Address1: 925 TRAILWOOD DR
Address2:  
City: YOUNGSTOWN
State: OH
PostalCode: 445125008
CountryCode: US
TelephoneNumber: 3307587575
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/28/2005
LastUpdateDate: 01/27/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/27/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0200X35098211OHY Allopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
207RP1001X35098211OHN Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease

No ID Information.


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