Provider Demographics
NPI:1497067847
Name:BASHAR PHAROAN MD PA
Entity Type:Organization
Organization Name:BASHAR PHAROAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BASHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAROAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-661-9300
Mailing Address - Street 1:4744 RIDGE RD
Mailing Address - Street 2:RIDGE MEDICAL CENTER
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-3818
Mailing Address - Country:US
Mailing Address - Phone:410-661-9300
Mailing Address - Fax:443-213-1441
Practice Address - Street 1:4744 RIDGE RD
Practice Address - Street 2:RIDGE MEDICAL CENTER
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-3818
Practice Address - Country:US
Practice Address - Phone:410-661-9300
Practice Address - Fax:443-213-1441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0019637174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD975311700Medicaid
MDB66869Medicare UPIN
MD975311700Medicaid