Individual
DR. BAHRAM PISHDAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
600 LARGO RD, LARGO, MD 20774-2122
(703) 855-1036
(703) 255-5378
Mailing address
8220 CRESTWOOD HEIGHTS DR, APT 607, MC LEAN, VA 22102-3129
(703) 855-1036
(703) 255-5378
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
D0051520
MD
208D00000X
General Practice Physician
0101052350
VA
208D00000X
General Practice Physician
Primary
D0051520
MD
208D00000X
General Practice Physician
MD21812
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017251600
—
DC
05
—
795007100
—
MD
Enumeration date
11/08/2006
Last updated
12/19/2018
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