Provider Demographics
NPI:1700131729
Name:COMMUNITY SURGICAL PRACTICE,INC
Entity type:Organization
Organization Name:COMMUNITY SURGICAL PRACTICE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BIJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAHMANYAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-345-6222
Mailing Address - Street 1:7600 ORA GLEN DR
Mailing Address - Street 2:P O BOX 254
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20768-7607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:301-345-4130
Practice Address - Street 1:7311 HANOVER PKWY STE B
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28759208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty