1750356788 NPI number — BAHRAM FOROUZANDEH M.D.

Table of content: BAHRAM FOROUZANDEH M.D. (NPI 1750356788)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750356788 NPI number — BAHRAM FOROUZANDEH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOROUZANDEH
Provider First Name:
BAHRAM
Provider Middle Name:
Provider Name Prefix Text:
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750356788
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5000 KY ROUTE 321
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRESTONSBURG
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41653-9113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-886-7645
Provider Business Mailing Address Fax Number:
606-889-6206

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5000 KY ROUTE 321
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRESTONSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41653-9113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-886-7645
Provider Business Practice Location Address Fax Number:
606-889-6206
Provider Enumeration Date:
02/22/2006

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: 174400000X , with the licence number:  31205 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: 31205 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1541974 . This is a "UMWA PIN NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1097430 . This is a "PASSPORT HEALTH PIN #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 5274306 . This is a "AETNA PIN NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000323512 . This is a "ANTHEM BC/BS PIN NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1171556 . This is a "CHA HEALTH PIN NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 6000540000 . This is a "WV MEDICAID PIN NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64312051 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00098815 . This is a "RAILROAD MEDICARE PIN #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 607181400 . This is a "FEDERAL BLACK LUNG PIN #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com