Healthcare Provider Details

I. General information

NPI: 1376706408
Provider Name (Legal Business Name): HAMID KIABAYAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 03/07/2023
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 HOSPITAL DR
GLEN BURNIE MD
21061-5803
US

IV. Provider business mailing address

7250 PARKWAY DR STE 500
HANOVER MD
21076-1343
US

V. Phone/Fax

Practice location:
  • Phone: 410-787-4527
  • Fax: 410-595-1992
Mailing address:
  • Phone: 410-787-4527
  • Fax: 410-595-1992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD437951
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD437951
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0069318
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: