Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 0101053696 | VA |
Y | 207YP0228X | Pediatric Otolaryngology | 0101053696 | VA |
NPI | 1053377903 |
---|---|
Provider Name | Dr. Robert S Bahadori |
First Address | Fairfax, VA 22030-2503 |
Second Address | Fairfax, VA 22031-5207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 21/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0009 | CAREFIRST (01) | |
006715176 | (05) | VA |
0101053696 | LICENSE # (01) | VA |
E70804 | (02) |