Healthcare Provider Details

I. General information

NPI: 1396682662
Provider Name (Legal Business Name): MAHSA BAYATI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 MILL POND RD STE H
FREDERICK MD
21701-9428
US

IV. Provider business mailing address

12316 SOUR CHERRY WAY
NORTH POTOMAC MD
20878-4710
US

V. Phone/Fax

Practice location:
  • Phone: 301-845-5400
  • Fax:
Mailing address:
  • Phone: 703-919-7250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: