Provider Demographics
NPI:1407980832
Name:TAHERI, JAMSHID M (MD)
Entity Type:Individual
Prefix:
First Name:JAMSHID
Middle Name:M
Last Name:TAHERI
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 1:6196 OXON HILL RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3100
Mailing Address - Country:US
Mailing Address - Phone:301-567-9777
Mailing Address - Fax:301-839-7367
Practice Address - Street 1:6196 OXON HILL RD
Practice Address - Street 2:SUITE 290
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3100
Practice Address - Country:US
Practice Address - Phone:301-567-9777
Practice Address - Fax:301-839-7367
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0021856208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB93969Medicare UPIN
MD170218Medicare PIN