Provider Demographics
NPI:1134144082
Name:BAHRAMI, SIAMACK (MD)
Entity Type:Individual
Prefix:DR
First Name:SIAMACK
Middle Name:
Last Name:BAHRAMI
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 1:8957-K EDMONSTON RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770
Mailing Address - Country:US
Mailing Address - Phone:301-982-9333
Mailing Address - Fax:301-441-3672
Practice Address - Street 1:8957-K EDMONSTON RD
Practice Address - Street 2:SUITE K
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770
Practice Address - Country:US
Practice Address - Phone:301-982-9333
Practice Address - Fax:301-441-3672
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0000248207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD36265OtherOC
MD3781OtherBCBS
06699OtherAMERIGROUP
MD0116334OtherAETNA
06699OtherAMERIGROUP
MD36265OtherOC