Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | D0000248 | MD |
NPI | 1134144082 |
---|---|
Provider Name | Dr. Siamack Bahrami |
First Address | Greenbelt, MD 20770 |
Second Address | Greenbelt, MD 20770 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0116334 | AETNA (01) | MD |
06699 | AMERIGROUP (01) | |
36265 | OC (01) | MD |
3781 | BCBS (01) | MD |
D84579 | (02) |