Provider Demographics
NPI:1326010562
Name:BEJJANI, GHASSAN K (MD)
Entity Type:Individual
Prefix:DR
First Name:GHASSAN
Middle Name:K
Last Name:BEJJANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7072 BENNINGTON WOODS DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-6374
Mailing Address - Country:US
Mailing Address - Phone:412-616-9599
Mailing Address - Fax:
Practice Address - Street 1:125 WARRENDALE BAYNE RD
Practice Address - Street 2:
Practice Address - City:WARRENDALE
Practice Address - State:PA
Practice Address - Zip Code:15086-7570
Practice Address - Country:US
Practice Address - Phone:412-616-9599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065792L174400000X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA755226OtherMC PTAN
PA001712523Medicaid
PA750725OtherMC PTAN
PAG80049Medicare UPIN