MEDICARE: ABOL HASSAN POURHAMIDI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	D0022930	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1974	OTHER	DC	CARE FIRST BCBS

General Provider Information

NPI Number	:	1366419053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABOL HASSAN POURHAMIDI MD

Provider Business Mailing Address
First Line	:	PO BOX 658
Second Line	:
City	:	GLEN ECHO
State	:	MD
Zip	:	20812-0658
Country	:	US
Telephone Number	:	301-459-2990
Fax Number	:	301-459-2991

Provider Business Practice Location Address
First Line	:	8100 GOOD LUCK RD
Second Line	:	STE 401
City	:	LANHAM
State	:	MD
Zip	:	20706-3512
Country	:	US
Telephone Number	:	301-459-2990
Fax Number	:	301-459-2991

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	07/08/2007

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