Provider Demographics
NPI:1801199427
Name:BAHRAM PISHDAD MD, P.C.
Entity Type:Organization
Organization Name:BAHRAM PISHDAD MD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BAHRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PISHDAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PC
Authorized Official - Phone:202-562-0400
Mailing Address - Street 1:9900 RUSTIC RAIL LN
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22181-5374
Mailing Address - Country:US
Mailing Address - Phone:202-562-0400
Mailing Address - Fax:703-255-5378
Practice Address - Street 1:1328 SOUTHERN AVE SE
Practice Address - Street 2:SUITE 310
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4689
Practice Address - Country:US
Practice Address - Phone:202-562-0400
Practice Address - Fax:703-255-5378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD51520208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD795007100Medicaid