Provider Demographics
NPI:1073504700
Name:REDJAEE, BAHRAM (MD)
Entity Type:Individual
Prefix:
First Name:BAHRAM
Middle Name:
Last Name:REDJAEE
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 1:4467 OLD BRANCH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-1854
Mailing Address - Country:US
Mailing Address - Phone:301-899-8900
Mailing Address - Fax:301-899-2963
Practice Address - Street 1:4467 OLD BRANCH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-1854
Practice Address - Country:US
Practice Address - Phone:301-899-8900
Practice Address - Fax:301-899-2963
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0039691207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD207600400Medicaid
E44388Medicare UPIN
MD1871594846Medicare PIN