Provider Demographics
NPI:1053413724
Name:UDVARHELYI, IAN STEVEN (MD)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:STEVEN
Last Name:UDVARHELYI
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 1:2185 WYNDTREE LN
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-2343
Mailing Address - Country:US
Mailing Address - Phone:610-407-7075
Mailing Address - Fax:610-407-4520
Practice Address - Street 1:2185 WYNDTREE LN
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-2343
Practice Address - Country:US
Practice Address - Phone:610-407-7075
Practice Address - Fax:610-407-4520
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070055L207R00000X
MA57945207R00000X
DEC1-0005898207R00000X
NJ25MA05721900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine