Provider Demographics
NPI:1184813503
Name:CYRUS HAMIDI, M.D., P.A.
Entity type:Organization
Organization Name:CYRUS HAMIDI, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CYRUS
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMIDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-472-6560
Mailing Address - Street 1:913 RIDGEBROOK RD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9455
Mailing Address - Country:US
Mailing Address - Phone:410-472-6560
Mailing Address - Fax:
Practice Address - Street 1:913 RIDGEBROOK RD
Practice Address - Street 2:SUITE 312
Practice Address - City:SPARKS
Practice Address - State:MD
Practice Address - Zip Code:21152-9455
Practice Address - Country:US
Practice Address - Phone:410-472-6560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD377ROtherINDIVIDUAL MEDICARE PIN
MD1134102775OtherINDIVIDUAL NPI
MD1134102775OtherINDIVIDUAL NPI
MD377RMedicare PIN