Provider Demographics
NPI:1669962924
Name:SEDAGHATPOUR, DILLON (MD)
Entity type:Individual
Prefix:
First Name:DILLON
Middle Name:
Last Name:SEDAGHATPOUR
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 1:401 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:CARLE PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11514-2122
Mailing Address - Country:US
Mailing Address - Phone:516-877-0977
Mailing Address - Fax:
Practice Address - Street 1:401 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:CARLE PLACE
Practice Address - State:NY
Practice Address - Zip Code:11514-2122
Practice Address - Country:US
Practice Address - Phone:516-877-0977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-12
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317731207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery