Provider Demographics
NPI:1285619882
Name:ZOLGHADRI, SIAVASH (MD)
Entity type:Individual
Prefix:
First Name:SIAVASH
Middle Name:
Last Name:ZOLGHADRI
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 1:6 HEARTHSTONE CT
Mailing Address - Street 2:SUITE 303
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-3065
Mailing Address - Country:US
Mailing Address - Phone:610-779-4449
Mailing Address - Fax:610-779-0677
Practice Address - Street 1:6 HEARTHSTONE CT
Practice Address - Street 2:SUITE 303
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-3065
Practice Address - Country:US
Practice Address - Phone:610-779-4449
Practice Address - Fax:610-779-0677
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034494L207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006597170003Medicaid
PAC31218Medicare UPIN
PA133068FWSMedicare ID - Type Unspecified