Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | CN4738 | MD |
NPI | 1134102775 |
---|---|
Provider Name | Dr. Cyrus Hamidi |
First Address | Sparks, MD 21152-9451 |
Second Address | Sparks, MD 21152-9451 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2005 |
Last Update Date | 04/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
645700200 | (05) | MD |
G46064 | (02) | MD |