Provider Demographics
NPI:1033195086
Name:BEHNAM, MOHAMMAD ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:ALI
Last Name:BEHNAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 BISHOP WALSH RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-1845
Mailing Address - Country:US
Mailing Address - Phone:301-759-3924
Mailing Address - Fax:301-759-4632
Practice Address - Street 1:925 BISHOP WALSH RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1845
Practice Address - Country:US
Practice Address - Phone:301-759-3924
Practice Address - Fax:301-759-4632
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD19469207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD782981700Medicaid
1445Medicare ID - Type Unspecified
D76420Medicare UPIN