Healthcare Provider Details

I. General information

NPI: 1609839695
Provider Name (Legal Business Name): A PIERRE BAMDAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 03/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 COMMERCE PKWY SUITE 100
LIMA OH
45804-4034
US

IV. Provider business mailing address

951 COMMERCE PKWY SUITE 101
LIMA OH
45804-4040
US

V. Phone/Fax

Practice location:
  • Phone: 419-224-5915
  • Fax: 419-224-5918
Mailing address:
  • Phone: 419-998-4575
  • Fax: 419-998-4586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35054123B
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier060064242
Identifier TypeOTHER
Identifier State
Identifier IssuerRR MEDICARE
# 2
Identifier0740970
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer
# 3
Identifier0634801
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerMEDICARE NUMBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: