Healthcare Provider Details

I. General information

NPI: 1134102775
Provider Name (Legal Business Name): CYRUS HAMIDI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12221 TULLAMORE RD
LUTHERVILLE TIMONIUM MD
21093-7816
US

IV. Provider business mailing address

12221 TULLAMORE RD
LUTHERVILLE TIMONIUM MD
21093-7816
US

V. Phone/Fax

Practice location:
  • Phone: 410-308-7840
  • Fax: 410-308-7841
Mailing address:
  • Phone: 410-308-7840
  • Fax: 410-308-7841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberCN4738
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: