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General NPI Number Information
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NPI Number | 1407045743
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Entity Type | Organization
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Legal Business Name | IMANOEL ENTERPRISE, INC
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Dates
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Enumeration Date | 10/23/2007
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Last Update Date | 10/19/2011
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Provider Practice Location Address
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Address Line | 218 WASHINGTON HEIGHTS MED CTR
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City | WESTMINSTER
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State | MD
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Zip | 21157-5633
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Country | US
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Telephone | 410-751-5830
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Fax | 410-751-7450
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Provider Business Mailing Address
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Address Line | 9115 FIELD RD
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City | BALTIMORE
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State | MD
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Zip | 21208-1003
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Country | US
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Telephone | 410-751-5830
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Fax |
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | BABAK IMANOEL
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Credential | DO
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Telephone | 410-751-5830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | H53939
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License Number State | MD
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