Provider Demographics
NPI:1356715924
Name:VISITING MD INC
Entity type:Organization
Organization Name:VISITING MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:BAHRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BAHRAMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-480-4310
Mailing Address - Street 1:2934 INGELOW ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-2311
Mailing Address - Country:US
Mailing Address - Phone:760-480-4310
Mailing Address - Fax:760-480-4350
Practice Address - Street 1:2934 INGELOW ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-2311
Practice Address - Country:US
Practice Address - Phone:760-480-4310
Practice Address - Fax:760-480-4350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-19
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB246616Medicare PIN
CAP47282Medicare PIN
CACB246616Medicare PIN