Provider Demographics
NPI:1700876349
Name:SADR, FARROKH S (MD)
Entity Type:Individual
Prefix:DR
First Name:FARROKH
Middle Name:S
Last Name:SADR
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 1:421 W CHEW ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-3406
Mailing Address - Country:US
Mailing Address - Phone:610-776-5100
Mailing Address - Fax:610-663-3113
Practice Address - Street 1:451 W CHEW ST
Practice Address - Street 2:SUITE 409
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-3472
Practice Address - Country:US
Practice Address - Phone:610-770-3130
Practice Address - Fax:610-770-3452
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017013E208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
0040189000OtherIBC
20033760OtherAMERIHEALTH MERCY
151312OtherHIGHMARK BLUE SHIELD
50049421OtherCBC
PA1007777690004Medicaid
1526085OtherGATEWAY HEALTH PLAN
P00099038OtherRR MEDICARE
159744OtherUNISON
PA151312HR2Medicare PIN
P00099038OtherRR MEDICARE