Provider Demographics
NPI:1407061229
Name:GHODRAT DANESHDOOST ,M.D.,PC
Entity Type:Organization
Organization Name:GHODRAT DANESHDOOST ,M.D.,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GHODRAT
Authorized Official - Middle Name:
Authorized Official - Last Name:DANESHDOOST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-868-9619
Mailing Address - Street 1:4440 APPLE TREE LN
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-9062
Mailing Address - Country:US
Mailing Address - Phone:610-704-2416
Mailing Address - Fax:
Practice Address - Street 1:1250 GREENWOOD DR
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-3677
Practice Address - Country:US
Practice Address - Phone:610-868-9619
Practice Address - Fax:610-867-0145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037237L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty