Provider Demographics
NPI:1487630281
Name:GOLSORKHI, MUHAMMAD (MD)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:
Last Name:GOLSORKHI
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 1:880 ROSCOMMON RD
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1845
Mailing Address - Country:US
Mailing Address - Phone:610-527-5212
Mailing Address - Fax:610-527-5212
Practice Address - Street 1:880 ROSCOMMON RD
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1845
Practice Address - Country:US
Practice Address - Phone:610-527-5212
Practice Address - Fax:610-527-5212
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035963L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007210270001Medicaid
PA0007210270001Medicaid
PA0007210270001Medicaid