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Individual

DR. HAMID EHSANI-SHISHVAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
4940 EASTERN AVE, JOHNS HOPKINS BAYVIEW MEDICAL CENTER, DEP ER , BLG B2, BALTIMORE, MD 21224-2735
(410) 550-5177
Mailing address
PO BOX 64362, BALTIMORE, MD 21264-4362
(410) 550-5177

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4301083403
MI
207Q00000X
Family Medicine Physician
Primary
D0065701
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
4301083403
PHYSICIAN
MI
01
D0065701
STATE LICENSE
MD
Enumeration date
11/07/2006
Last updated
03/11/2008
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