Provider Demographics
NPI:1922685775
Name:EHSAEI, BAHAREH (MD)
Entity Type:Individual
Prefix:
First Name:BAHAREH
Middle Name:
Last Name:EHSAEI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7718 ENFIELD AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-1947
Mailing Address - Country:US
Mailing Address - Phone:703-678-9633
Mailing Address - Fax:
Practice Address - Street 1:850 KEMPSVILLE RD STE 200A
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3920
Practice Address - Country:US
Practice Address - Phone:757-261-5910
Practice Address - Fax:757-466-1611
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-26
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101281893207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine