Provider Demographics
NPI:1336568260
Name:BOZORGNIA, BEHDAD (MD)
Entity Type:Individual
Prefix:
First Name:BEHDAD
Middle Name:
Last Name:BOZORGNIA
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 1:2218 PINE ST APT 5
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6565
Mailing Address - Country:US
Mailing Address - Phone:610-248-0818
Mailing Address - Fax:
Practice Address - Street 1:1518 WALNUT ST STE 502
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-3403
Practice Address - Country:US
Practice Address - Phone:484-532-8903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-08
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4585962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty