Provider Demographics
NPI:1649235425
Name:BAHRAIN, MICHELLE LYNN (DO)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:BAHRAIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12212 RUNNING FENCE LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1194
Mailing Address - Country:US
Mailing Address - Phone:443-802-7620
Mailing Address - Fax:
Practice Address - Street 1:9000 FRANKLIN SQUARE DR DEPT OF
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-3901
Practice Address - Country:US
Practice Address - Phone:443-802-7620
Practice Address - Fax:410-780-4060
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0057147207RI0200X
MDH57147207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405157200Medicaid
MD405157200Medicaid
845M539FMedicare PIN
MDI04621Medicare UPIN