Provider Demographics
NPI:1902805252
Name:MORTAZAVI, STEVEN ALLIE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ALLIE
Last Name:MORTAZAVI
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 1:4250 FRITCH DR
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-9412
Mailing Address - Country:US
Mailing Address - Phone:610-954-9040
Mailing Address - Fax:610-954-9093
Practice Address - Street 1:4250 FRITCH DR
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-9412
Practice Address - Country:US
Practice Address - Phone:610-954-9040
Practice Address - Fax:610-954-9093
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD063450L207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG87896Medicare UPIN