Provider Demographics
NPI:1164428264
Name:MOMENI, BAHADOR (MD)
Entity Type:Individual
Prefix:MR
First Name:BAHADOR
Middle Name:
Last Name:MOMENI
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 1:920 ELKRIDGE LANDING RD
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM
Mailing Address - State:MD
Mailing Address - Zip Code:21090
Mailing Address - Country:US
Mailing Address - Phone:443-462-5010
Mailing Address - Fax:410-684-2031
Practice Address - Street 1:8601 VETERANS HWY
Practice Address - Street 2:STE 211
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-1547
Practice Address - Country:US
Practice Address - Phone:410-553-8090
Practice Address - Fax:410-729-2404
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD50254207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD908TMedicare PIN
MDK245908TMedicare PIN
MD110150107Medicare PIN
MDG50253Medicare UPIN
MDCE9203Medicare PIN