Provider Demographics
NPI:1235228354
Name:BAHADORI, LILA MOJDEH (MD)
Entity Type:Individual
Prefix:DR
First Name:LILA
Middle Name:MOJDEH
Last Name:BAHADORI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8229 OSAGE LANE
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817
Mailing Address - Country:US
Mailing Address - Phone:301-263-0068
Mailing Address - Fax:
Practice Address - Street 1:10301 GEORGIA AVENUE
Practice Address - Street 2:SUITE 304
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902
Practice Address - Country:US
Practice Address - Phone:301-681-7200
Practice Address - Fax:301-681-5968
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0047928207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD260990800Medicaid
G68497Medicare UPIN
MD260990800Medicaid