Provider Demographics
NPI:1366468399
Name:MALEKPOUR, BAHMAN (MD)
Entity Type:Individual
Prefix:
First Name:BAHMAN
Middle Name:
Last Name:MALEKPOUR
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:PO BOX 1342
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27533-1342
Mailing Address - Country:US
Mailing Address - Phone:919-734-2222
Mailing Address - Fax:919-734-2229
Practice Address - Street 1:2805 MCLAMB PL
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-1647
Practice Address - Country:US
Practice Address - Phone:919-734-2222
Practice Address - Fax:919-734-2229
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC213592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC53772OtherBLUE CROSS INDIVIDUAL
NC8953772Medicaid
NC890184GMedicaid
NC0184GOtherBLUE CROSS GROUP
NCC80924Medicare UPIN
NC890184GMedicaid