Provider Demographics
NPI:1952458739
Name:RAHNAMA, MOHAMMAD REZA (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:REZA
Last Name:RAHNAMA
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 1:9512 HARFORD RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-3100
Mailing Address - Country:US
Mailing Address - Phone:410-665-4400
Mailing Address - Fax:410-661-2420
Practice Address - Street 1:9512 HARFORD RD STE 4
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-3127
Practice Address - Country:US
Practice Address - Phone:410-665-4400
Practice Address - Fax:410-661-2420
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0045475207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE268-0002OtherFEDERAL BLUE SHIELD
MD110118499OtherMEDICARE RAILROAD
MD371241900Medicaid
MD53440804OtherBLUE SHEILD OF MD
MD552987OtherAETNA PLANS
MD53440804OtherBLUE SHEILD OF MD
MDG02597Medicare UPIN