Basic Information
| Provider Information | |||||||||
| NPI: | 1164428264 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOMENI | ||||||||
| FirstName: | BAHADOR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 920 ELKRIDGE LANDING RD | ||||||||
| Address2: | |||||||||
| City: | LINTHICUM | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434625010 | ||||||||
| FaxNumber: | 4106842031 | ||||||||
| Practice Location | |||||||||
| Address1: | 8601 VETERANS HWY | ||||||||
| Address2: | STE 211 | ||||||||
| City: | MILLERSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211081547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105538090 | ||||||||
| FaxNumber: | 4107292404 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2005 | ||||||||
| LastUpdateDate: | 06/20/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D50254 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.