Provider Demographics
NPI:1730593377
Name:LOTFI MOGHADDAS, BANAFSHEH (MD)
Entity type:Individual
Prefix:DR
First Name:BANAFSHEH
Middle Name:
Last Name:LOTFI MOGHADDAS
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 1:24 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-1280
Mailing Address - Country:US
Mailing Address - Phone:814-368-1000
Mailing Address - Fax:814-368-1008
Practice Address - Street 1:24 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-1280
Practice Address - Country:US
Practice Address - Phone:814-368-1000
Practice Address - Fax:814-368-1008
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD461587207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine