Healthcare Provider Details

I. General information

NPI: 1902044241
Provider Name (Legal Business Name): DR. SARA BEHMANESH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2009
Last Update Date: 01/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 ROCKVILLE PIKE STE 10
ROCKVILLE MD
20852-1658
US

IV. Provider business mailing address

218 N CHARLES ST APT 1610
BALTIMORE MD
21201-4091
US

V. Phone/Fax

Practice location:
  • Phone: 301-770-5400
  • Fax:
Mailing address:
  • Phone: 301-704-2874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14146
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: