Healthcare Provider Details

I. General information

NPI: 1518293240
Provider Name (Legal Business Name): MONA N BAHOUTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2009
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST STE 446
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

30 NORTHWOOD DR
LUTHERVILLE TIMONIUM MD
21093-4219
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-0623
  • Fax:
Mailing address:
  • Phone: 410-252-0944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberD78293
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberD78293
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: