Provider Demographics
NPI:1063523835
Name:BIGDELI, HOMAYOON (MD)
Entity type:Individual
Prefix:
First Name:HOMAYOON
Middle Name:
Last Name:BIGDELI
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 1:65 E ELIZABETH AVE
Mailing Address - Street 2:SUITE 708
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-6506
Mailing Address - Country:US
Mailing Address - Phone:610-868-9118
Mailing Address - Fax:610-868-9446
Practice Address - Street 1:65 E ELIZABETH AVE
Practice Address - Street 2:SUITE 708
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6506
Practice Address - Country:US
Practice Address - Phone:610-868-9118
Practice Address - Fax:610-868-9446
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD350092L207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB66633Medicare UPIN
PA427509S3YMedicare ID - Type Unspecified