Provider Demographics
NPI:1346224235
Name:TABATABAI, HAMID (MD)
Entity Type:Individual
Prefix:DR
First Name:HAMID
Middle Name:
Last Name:TABATABAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HAMID
Other - Middle Name:
Other - Last Name:TABATABAI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:744 DULANEY VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-5132
Mailing Address - Country:US
Mailing Address - Phone:443-777-7077
Mailing Address - Fax:
Practice Address - Street 1:744 DULANEY VALLEY RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-5132
Practice Address - Country:US
Practice Address - Phone:410-931-9280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-04
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00187392084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
C57592Medicare UPIN