Provider Demographics
NPI:1043263932
Name:MAHARLOUEI, BABAK (MD)
Entity Type:Individual
Prefix:DR
First Name:BABAK
Middle Name:
Last Name:MAHARLOUEI
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:PO BOX 7025
Mailing Address - Street 2:
Mailing Address - City:AMAGANSETT
Mailing Address - State:NY
Mailing Address - Zip Code:11930-7025
Mailing Address - Country:US
Mailing Address - Phone:888-877-3850
Mailing Address - Fax:631-329-6951
Practice Address - Street 1:265 HERRICK RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-5045
Practice Address - Country:US
Practice Address - Phone:631-726-8350
Practice Address - Fax:631-726-8519
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY231067207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0831T1OtherEMPIRE BLUE CROSS BLUE SH
NY9L2171Medicare PIN