Healthcare Provider Details

I. General information

NPI: 1043151269
Provider Name (Legal Business Name): SEYED MAHMOOD BATHAIIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12307 BRAXFIELD CT APT 9
NORTH BETHESDA MD
20852-2022
US

IV. Provider business mailing address

12307 BRAXFIELD CT APT 9
NORTH BETHESDA MD
20852-2022
US

V. Phone/Fax

Practice location:
  • Phone: 202-039-0365
  • Fax:
Mailing address:
  • Phone: 202-039-0365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: