Provider Demographics
NPI:1013900992
Name:BAHMANYAR, BIJAN (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:BIJAN
Middle Name:
Last Name:BAHMANYAR
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 254
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20768-0254
Mailing Address - Country:US
Mailing Address - Phone:301-345-6222
Mailing Address - Fax:301-345-4130
Practice Address - Street 1:7311 HANOVER PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2033
Practice Address - Country:US
Practice Address - Phone:301-345-6222
Practice Address - Fax:301-345-4130
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD28759174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD442921400Medicaid
MDBA156765Medicare ID - Type Unspecified
MD442921400Medicaid