Provider Demographics
NPI:1144214727
Name:BAHRANI, ASHKAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHKAN
Middle Name:
Last Name:BAHRANI
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 1:9114 PHILADELPHIA RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4317
Mailing Address - Country:US
Mailing Address - Phone:410-687-5300
Mailing Address - Fax:410-682-4418
Practice Address - Street 1:9114 PHILADELPHIA RD
Practice Address - Street 2:SUITE 208
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4317
Practice Address - Country:US
Practice Address - Phone:410-687-5300
Practice Address - Fax:410-682-4418
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD54841207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD001079100Medicaid
MDG73239Medicare UPIN
MD219879YEWYMedicare PIN