Healthcare Provider Details

I. General information

NPI: 1366419053
Provider Name (Legal Business Name): ABOL HASSAN POURHAMIDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 GOOD LUCK RD STE 401
LANHAM MD
20706-3512
US

IV. Provider business mailing address

PO BOX 658
GLEN ECHO MD
20812-0658
US

V. Phone/Fax

Practice location:
  • Phone: 301-459-2990
  • Fax: 301-459-2991
Mailing address:
  • Phone: 301-459-2990
  • Fax: 301-459-2991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberD0022930
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: