Provider Demographics
NPI:1275618621
Name:SAJADI, MOHAMMAD REZA (MD FACC)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:REZA
Last Name:SAJADI
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:DR
Other - First Name:REZA
Other - Middle Name:
Other - Last Name:SAJADI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD FACC
Mailing Address - Street 1:1005 NORTH POINT BLVD
Mailing Address - Street 2:STE 706
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224
Mailing Address - Country:US
Mailing Address - Phone:410-282-9384
Mailing Address - Fax:410-282-9386
Practice Address - Street 1:1005 NORTH POINT BLVD
Practice Address - Street 2:STE 706
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224
Practice Address - Country:US
Practice Address - Phone:410-282-9384
Practice Address - Fax:410-282-9386
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0018951207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
06199OtherAMERICAID
0402805OtherUNITED HEALTHCARE
2500076OtherSPEC
110003966OtherTRAVLERS
2179567OtherAETNA
36020007OtherRENDERING PROVIDER
MD138831200Medicaid
7362OtherBCBS
36020007OtherRENDERING PROVIDER
D72300Medicare UPIN