Provider Demographics
NPI:1881988384
Name:SOROORI RAD, BAHAREH (MD)
Entity type:Individual
Prefix:
First Name:BAHAREH
Middle Name:
Last Name:SOROORI RAD
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 I ST NW STE 1000
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-3729
Mailing Address - Country:US
Mailing Address - Phone:202-296-8252
Mailing Address - Fax:
Practice Address - Street 1:1712 I ST NW STE 1000
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-3729
Practice Address - Country:US
Practice Address - Phone:202-296-8252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
DCMD042979207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program