Provider Demographics
NPI:1821085317
Name:OREIZI ESFAHANI, MOHAMMAD EBRAHIM (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:EBRAHIM
Last Name:OREIZI ESFAHANI
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 1:531 OLD WESTMINSTER PIKE STE 202
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6276
Mailing Address - Country:US
Mailing Address - Phone:410-465-0576
Mailing Address - Fax:
Practice Address - Street 1:531 OLD WESTMINSTER PIKE STE 202
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6276
Practice Address - Country:US
Practice Address - Phone:410-465-0576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD44533207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD055503700Medicaid
MD055503700Medicaid
MD245SMedicare ID - Type Unspecified