Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | D0057120 | MD |
Y | 111NI0900X | Internist | D0057120 | MD |
N | 208000000X | Pediatrician | D0057120 | MD |
NPI | 1003912742 |
---|---|
Provider Name | Dr. Mariam Mcconnell Bahrami |
First Address | Bowie, MD 20716-2603 |
Second Address | Bowie, MD 20716-2603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 28/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
820801800 | (05) | MD |
H51554 | (02) | MD |