Provider Demographics
NPI:1649485640
Name:SAJADI-ERNAZAROVA, KARIMA RAFAEL (MD)
Entity type:Individual
Prefix:
First Name:KARIMA
Middle Name:RAFAEL
Last Name:SAJADI-ERNAZAROVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710B S COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1930
Mailing Address - Country:US
Mailing Address - Phone:215-732-2142
Mailing Address - Fax:
Practice Address - Street 1:501 S 54TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-1900
Practice Address - Country:US
Practice Address - Phone:215-732-2142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD431636207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1963860OtherBLUE SHIELD
PA1020377640001OtherPROMISE
PA1963860OtherHIGHMARK BS
30044949OtherKEYSTONE MERCY
PA1020377640Medicaid
PA2843651000OtherKEYSTONE
NJ0299740Medicaid