1326061672 NPI number — DR. SHAHAB ZARE BAVANI M.D.

Table of content: DR. SHAHAB ZARE BAVANI M.D. (NPI 1326061672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326061672 NPI number — DR. SHAHAB ZARE BAVANI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAVANI
Provider First Name:
SHAHAB
Provider Middle Name:
ZARE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAWANI
Provider Other First Name:
SHAHAB
Provider Other Middle Name:
ZARE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326061672
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10724 LITTLE PATUXENT PKWY STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21044-3249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-997-5944
Provider Business Mailing Address Fax Number:
410-997-1720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7300 VAN DUSEN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAUREL
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20707-9463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-730-7440
Provider Business Practice Location Address Fax Number:
414-073-0747
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  D0064874 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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