MEDICARE: MR. BAHADOR MOMENI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	D50254	MD

General Provider Information

NPI Number	:	1164428264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BAHADOR MOMENI M.D.

Provider Business Mailing Address
First Line	:	920 ELKRIDGE LANDING RD
Second Line	:
City	:	LINTHICUM
State	:	MD
Zip	:	21090
Country	:	US
Telephone Number	:	443-462-5010
Fax Number	:	410-684-2031

Provider Business Practice Location Address
First Line	:	8601 VETERANS HWY
Second Line	:	STE 211
City	:	MILLERSVILLE
State	:	MD
Zip	:	21108-1547
Country	:	US
Telephone Number	:	410-553-8090
Fax Number	:	410-729-2404

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	06/20/2016

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