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Individual

MANILA BAGHERZADEH-AZAR

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
3400 SPRUCE ST, RADIOLOGY ADMINISTRATION, 1 SILVERSTEIN STE 130, PHILADELPHIA, PA 19104-4206
(610) 688-3643
Mailing address
3400 SPRUCE ST, RADIOLOGY ADMINISTRATION, 1 SILVERSTEIN STE 130, PHILADELPHIA, PA 19104-4206
(610) 688-3643

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD436864
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
156606001
AR
01
P00210259
RAILROAD MEDICARE
AR
Enumeration date
09/27/2006
Last updated
10/18/2024
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