Basic Information
| Provider Information | |||||||||
| NPI: | 1609230200 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEDIGH HAGHIGHAT | ||||||||
| FirstName: | GILLIAN | ||||||||
| MiddleName: | BACH | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | BACH | ||||||||
| OtherFirstName: | GILLIAN | ||||||||
| OtherMiddleName: | NOEL | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 103 HAWS LN | ||||||||
| Address2: | |||||||||
| City: | FLOURTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190312063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043582665 | ||||||||
| FaxNumber: | 2156622875 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 S 11TH ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159556000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2016 | ||||||||
| LastUpdateDate: | 07/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD466291 | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.