Provider Demographics
NPI:1639168099
Name:BASHARMAL, SIAR AHMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:SIAR
Middle Name:AHMAD
Last Name:BASHARMAL
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 1:1006 BUTTERNUT CT
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-7488
Mailing Address - Country:US
Mailing Address - Phone:310-851-4705
Mailing Address - Fax:
Practice Address - Street 1:1251 W REDONDO BEACH BLVD
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3456
Practice Address - Country:US
Practice Address - Phone:310-851-4705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91350207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine