Provider Demographics
NPI:1790734549
Name:BAHRAIN, HUZEFA F (DO)
Entity Type:Individual
Prefix:
First Name:HUZEFA
Middle Name:F
Last Name:BAHRAIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5233 KING AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4001
Mailing Address - Country:US
Mailing Address - Phone:410-780-4050
Mailing Address - Fax:410-780-4060
Practice Address - Street 1:5233 KING AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4001
Practice Address - Country:US
Practice Address - Phone:410-780-4050
Practice Address - Fax:410-780-4060
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0057173207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD367992600Medicaid
MDP00425697OtherRR MEDICARE PTAN
MDP00425697OtherRR MEDICARE PTAN
522343901OtherFEDERAL TIN
MD160M0164Medicare ID - Type Unspecified