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General NPI Number Information
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NPI Number | 1710110366
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Entity Type | Individual
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Provider Name | HAYSAM BAHO M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2009
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 9548 SURVEYOR CT
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City | MANASSAS
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State | VA
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Zip | 20110-4406
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Country | US
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Telephone | 703-369-9090
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Fax | 703-392-9646
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Provider Business Mailing Address
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Address Line | 800 BRADBURY DR SE STE 116
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-4310
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Country | US
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Telephone | 505-272-1476
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Fax | 703-724-4408
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | MD2024-0880
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License Number State | NM
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