Provider Demographics
NPI:1780742833
Name:ZAMANI, MOHAMMAD H (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:H
Last Name:ZAMANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 FONTANA LN
Mailing Address - Street 2:STE 107 109
Mailing Address - City:BALTO
Mailing Address - State:MD
Mailing Address - Zip Code:21237
Mailing Address - Country:US
Mailing Address - Phone:410-574-2630
Mailing Address - Fax:410-686-2894
Practice Address - Street 1:17 FONTANA LN
Practice Address - Street 2:STE 107 109
Practice Address - City:BALTO
Practice Address - State:MD
Practice Address - Zip Code:21237
Practice Address - Country:US
Practice Address - Phone:410-574-2630
Practice Address - Fax:410-686-2894
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0020285207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD812400100Medicaid
MD076BMedicare ID - Type Unspecified
MD812400100Medicaid