Provider Demographics
NPI:1114016979
Name:BAHMAN-PAYMAN
Entity Type:Organization
Organization Name:BAHMAN-PAYMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACOG
Authorized Official - Prefix:
Authorized Official - First Name:BAHMAN
Authorized Official - Middle Name:-
Authorized Official - Last Name:PAYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-546-1999
Mailing Address - Street 1:319 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24277-2533
Mailing Address - Country:US
Mailing Address - Phone:276-546-1999
Mailing Address - Fax:276-546-1999
Practice Address - Street 1:319 LOCUST ST
Practice Address - Street 2:
Practice Address - City:PENNINGTON GAP
Practice Address - State:VA
Practice Address - Zip Code:24277-2533
Practice Address - Country:US
Practice Address - Phone:276-546-1999
Practice Address - Fax:276-546-1999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101030609174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6215947Medicaid
VAB08742Medicare UPIN