Provider Demographics
NPI:1821164054
Name:BAKALIAN, SIMA HABIBI (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMA
Middle Name:HABIBI
Last Name:BAKALIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SIMA
Other - Middle Name:ANIS
Other - Last Name:HABIBI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2101 EJEFFERSON ST PPQA MEDICARE COMPILANCE UNIT 6 W
Mailing Address - Street 2:ATTN THERESA BROOKS KAISER PERMANENTA MIDATLANTIC
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-6660
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:10810 CONNECTICUT AVENUE
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2138
Practice Address - Country:US
Practice Address - Phone:301-929-7211
Practice Address - Fax:301-929-7027
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD19794208000000X
MDD0043387208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1821164054Medicaid
F51464Medicare UPIN