Provider Demographics
NPI:1043746878
Name:BAKHTIARI-NEJAD, FAEZEH (DPM)
Entity Type:Individual
Prefix:
First Name:FAEZEH
Middle Name:
Last Name:BAKHTIARI-NEJAD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3592
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 E ROLLING XRDS STE 55
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-6212
Practice Address - Country:US
Practice Address - Phone:410-455-9660
Practice Address - Fax:410-455-9665
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01747213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist