Provider Demographics
NPI:1033359336
Name:JAFARPOUR, BEHNAM (MD)
Entity Type:Individual
Prefix:
First Name:BEHNAM
Middle Name:
Last Name:JAFARPOUR
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 1:7920 MCDONOGH RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5273
Mailing Address - Country:US
Mailing Address - Phone:443-693-7246
Mailing Address - Fax:
Practice Address - Street 1:3421 BENSON AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-1056
Practice Address - Country:US
Practice Address - Phone:443-693-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD766062081P2900X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD654802400Medicaid
MD320306YY2LMedicare PIN