Basic Information
| Provider Information | |||||||||
| NPI: | 1700876349 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SADR | ||||||||
| FirstName: | FARROKH | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 421 W CHEW ST | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181023406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107765100 | ||||||||
| FaxNumber: | 6106633113 | ||||||||
| Practice Location | |||||||||
| Address1: | 451 W CHEW ST | ||||||||
| Address2: | SUITE 409 | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181023472 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107703130 | ||||||||
| FaxNumber: | 6107703452 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2005 | ||||||||
| LastUpdateDate: | 10/23/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | MD017013E | PA | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 0040189000 | 01 | IBC | OTHER | 20033760 | 01 | AMERIHEALTH MERCY | OTHER | 151312 | 01 | HIGHMARK BLUE SHIELD | OTHER | 50049421 | 01 | CBC | OTHER | 1007777690004 | 05 | PA | MEDICAID | 1526085 | 01 | GATEWAY HEALTH PLAN | OTHER | P00099038 | 01 | RR MEDICARE | OTHER | 159744 | 01 | UNISON | OTHER |