Provider Demographics
NPI:1568924553
Name:BAHDZEVICH, IRYNA (MD)
Entity Type:Individual
Prefix:
First Name:IRYNA
Middle Name:
Last Name:BAHDZEVICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10160 BUSTLETON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-3749
Mailing Address - Country:US
Mailing Address - Phone:215-677-0501
Mailing Address - Fax:
Practice Address - Street 1:10160 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3749
Practice Address - Country:US
Practice Address - Phone:215-677-0501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2023-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11674600207R00000X
390200000X
PAMD479846207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program