Provider Demographics
NPI:1669483962
Name:BAHREMAND, MANIJEH (MD)
Entity type:Individual
Prefix:DR
First Name:MANIJEH
Middle Name:
Last Name:BAHREMAND
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:PO BOX 380
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-0380
Mailing Address - Country:US
Mailing Address - Phone:215-723-2333
Mailing Address - Fax:215-257-1800
Practice Address - Street 1:1632 PINE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6711
Practice Address - Country:US
Practice Address - Phone:215-670-5843
Practice Address - Fax:215-735-7991
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053472L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015238940002Medicaid
PAG07849Medicare UPIN
PA222081Medicare PIN