Provider Demographics
NPI:1134102775
Name:HAMIDI, CYRUS (MD)
Entity Type:Individual
Prefix:DR
First Name:CYRUS
Middle Name:
Last Name:HAMIDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:913 RIDGEBROOK RD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9451
Mailing Address - Country:US
Mailing Address - Phone:410-472-6560
Mailing Address - Fax:410-472-6564
Practice Address - Street 1:913 RIDGEBROOK RD
Practice Address - Street 2:SUITE 312
Practice Address - City:SPARKS
Practice Address - State:MD
Practice Address - Zip Code:21152-9451
Practice Address - Country:US
Practice Address - Phone:410-472-6560
Practice Address - Fax:410-472-6564
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDCN4738207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD645700200Medicaid
MDG46064Medicare UPIN
MD645700200Medicaid