Provider Demographics
NPI:1679772727
Name:DR. MOHAMMAD ALI BEHNAM, M.D.,P.A.
Entity Type:Organization
Organization Name:DR. MOHAMMAD ALI BEHNAM, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:ALTAMARINO
Authorized Official - Last Name:BEHNAM
Authorized Official - Suffix:
Authorized Official - Credentials:BSMT,ASCP
Authorized Official - Phone:301-759-3924
Mailing Address - Street 1:925 BISHOP WALSH RD
Mailing Address - Street 2:SUITE # 7
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-1845
Mailing Address - Country:US
Mailing Address - Phone:301-759-3924
Mailing Address - Fax:301-759-4632
Practice Address - Street 1:841 QUINCE ORCHARD BLVD STE A
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-1615
Practice Address - Country:US
Practice Address - Phone:301-330-0660
Practice Address - Fax:301-759-4632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1445Medicare PIN