Provider Demographics
NPI:1073550802
Name:SHOLEVAR, BAHMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BAHMAN
Middle Name:
Last Name:SHOLEVAR
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 1:500 OFFICE CENTER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-3219
Mailing Address - Country:US
Mailing Address - Phone:215-540-2150
Mailing Address - Fax:215-540-8139
Practice Address - Street 1:340 S LIBERTY ST
Practice Address - Street 2:
Practice Address - City:ORWIGSBURG
Practice Address - State:PA
Practice Address - Zip Code:17961-2127
Practice Address - Country:US
Practice Address - Phone:570-366-5096
Practice Address - Fax:570-366-8755
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019943E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019213270003Medicaid
PAE80810Medicare UPIN
PA443933NNPMedicare ID - Type Unspecified