Provider Demographics
NPI:1477683258
Name:HAMIDEH, TAHANI I (OD)
Entity Type:Individual
Prefix:DR
First Name:TAHANI
Middle Name:I
Last Name:HAMIDEH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:TINA
Other - Middle Name:I
Other - Last Name:HAMIDEH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:5211 DAYBROOK CIR APT 240
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-5051
Mailing Address - Country:US
Mailing Address - Phone:410-258-3622
Mailing Address - Fax:
Practice Address - Street 1:14726 BALTIMORE AVE
Practice Address - Street 2:14728
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4816
Practice Address - Country:US
Practice Address - Phone:301-776-0075
Practice Address - Fax:301-604-9490
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA 1951152W00000X
VA0618001493152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist