Provider Demographics
NPI:1003912742
Name:BAHRAMI, MARIAM MCCONNELL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIAM
Middle Name:MCCONNELL
Last Name:BAHRAMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4379 NORTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-2603
Mailing Address - Country:US
Mailing Address - Phone:301-262-2627
Mailing Address - Fax:301-262-8411
Practice Address - Street 1:4379 NORTHVIEW DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-2603
Practice Address - Country:US
Practice Address - Phone:301-262-2627
Practice Address - Fax:301-262-8411
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057120207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD820801800Medicaid
MD820801800Medicaid
MD00A635A86Medicare PIN