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1720157647 NPI number — HAMID EHSANI-SHISHVAN MD

NPI Number: 1720157647
Health Care Provider/Practitioner: HAMID EHSANI-SHISHVAN MD

Information about “1720157647” NPI (HAMID EHSANI-SHISHVAN MD) exists in 1720157647 in HTML format HTML  |  1720157647 in plain Text format TXT  |  1720157647 in PDF (Portable Document Format) PDF  |  1720157647 in an XML format XML  formats.

NPI Number : 1720157647 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1720157647",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "EHSANI-SHISHVAN",
    "FirstName": "HAMID",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "EHSANI-SHISHVAN",
    "OtherFirstName": "HAMID",
    "OtherMiddleName": null,
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "MD",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "PO BOX 64362",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BALTIMORE",
    "MailingAddressStateName": "MD",
    "MailingAddressPostalCode": "21264-4362",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "410-550-5177",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4940 EASTERN AVE",
    "SecondLinePracticeLocationAddress": "JOHNS HOPKINS BAYVIEW MEDICAL CENTER, DEP ER , BLG B2",
    "PracticeLocationAddressCityName": "BALTIMORE",
    "PracticeLocationAddressStateName": "MD",
    "PracticeLocationAddressPostalCode": "21224-2735",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "410-550-5177",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/07/2006",
    "LastUpdateDate": "03/11/2008",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "4301083403",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "D0065701",
          "LicenseNumberStateCode": "MD",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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