Basic Information
Provider Information | |||||||||
NPI: | 1508210774 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BAHARANI | ||||||||
FirstName: | SHARADA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 6201 GREENLEIGH AVE | ||||||||
Address2: |   | ||||||||
City: | MIDDLE RIVER | ||||||||
State: | MD | ||||||||
PostalCode: | 212202004 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3045356343 | ||||||||
FaxNumber: | 3045354110 | ||||||||
Practice Location | |||||||||
Address1: | 8115 MAPLE LAWN BLVD STE 140 | ||||||||
Address2: |   | ||||||||
City: | FULTON | ||||||||
State: | MD | ||||||||
PostalCode: | 207592689 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2404591800 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/14/2016 | ||||||||
LastUpdateDate: | 12/14/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/14/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X |   |   | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 207Q00000X | D90469 | MD | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
No ID Information.