Provider Demographics
NPI:1881796985
Name:BAHRAM, RAMIN (DMD)
Entity type:Individual
Prefix:DR
First Name:RAMIN
Middle Name:
Last Name:BAHRAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2546 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-4638
Mailing Address - Country:US
Mailing Address - Phone:215-463-4141
Mailing Address - Fax:215-463-7616
Practice Address - Street 1:2546 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-4638
Practice Address - Country:US
Practice Address - Phone:215-463-4141
Practice Address - Fax:215-463-7616
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030599L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1954168Medicaid
PAU96058Medicare UPIN
PA71507Medicare ID - Type Unspecified