Individual
DR. OTAROD BAHRANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
600 GRESHAM DR FL 5, NORFOLK, VA 23507-1904
(757) 388-3198
(757) 388-4242
Mailing address
600 GRESHAM DR FL 5, NORFOLK, VA 23507-1904
(757) 388-3198
(757) 388-4242
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101051401
VA
208M00000X
Hospitalist Physician
0101051401
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
-028
TRICARE/CHAMPUS
VA
05
—
006079814
—
VA
01
—
0632M
NC BC/BS
NC
01
—
12882
SENTARA
VA
01
—
236909
UHC/MAMSI
VA
01
—
250721
ANTHEM
VA
05
—
890632M
—
NC
01
—
PAR
USA MANAGED CARE
VA
Enumeration date
01/30/2006
Last updated
01/16/2020
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