Provider Demographics
NPI:1912980608
Name:DANESHDOOST, GHODRAT O (MD)
Entity Type:Individual
Prefix:DR
First Name:GHODRAT
Middle Name:O
Last Name:DANESHDOOST
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1250 GREENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-3677
Mailing Address - Country:US
Mailing Address - Phone:610-868-9619
Mailing Address - Fax:610-867-0145
Practice Address - Street 1:1250 GREENWOOD DR
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-3677
Practice Address - Country:US
Practice Address - Phone:610-868-9619
Practice Address - Fax:610-867-0145
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD037237L207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE60888Medicare UPIN