Basic Information
| Provider Information | |||||||||
| NPI: | 1548609506 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SADJADI | ||||||||
| FirstName: | BAHAR | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2100 WALNUT ST | ||||||||
| Address2: | APARTMENT 6I | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191034810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5109187447 | ||||||||
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| Practice Location | |||||||||
| Address1: | 245 N 15TH ST | ||||||||
| Address2: | MAIL STOP 427 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191021101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157627698 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2013 | ||||||||
| LastUpdateDate: | 03/07/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD458853 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | PO1762008 | 01 | PA | RAILROAD MEDICARE | OTHER |