Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD434830 | PA |
N | 111NI0900X | Internist | MD434830 | PA |
N | 207RH0003X | Hematology & Oncology | 253372 | NY |
Y | 207RH0003X | Hematology & Oncology | D87116 | MD |
NPI | 1063675890 |
---|---|
Provider Name | Dr. Behzad Doratotaj |
First Address | Olney, MD 20832-1514 |
Second Address | Olney, MD 20832-1514 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2008 |
Last Update Date | 23/05/2019 |