MEDICARE: FARIBA BAGHAI 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	173000000X	Legal Medicine

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	KBD1R1	OTHER	MD	BLUE CROSS

General Provider Information

NPI Number	:	1336184696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARIBA BAGHAI M.D.

Provider Business Mailing Address
First Line	:	1835 UNIVERSITY BLVD E
Second Line	:	STE E
City	:	HYATTSVILLE
State	:	MD
Zip	:	20783-4600
Country	:	US
Telephone Number	:	301-434-3700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1835 UNIVERSITY BLVD E
Second Line	:	STE E
City	:	HYATTSVILLE
State	:	MD
Zip	:	20783-4600
Country	:	US
Telephone Number	:	301-434-3700
Fax Number	:

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

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	07/08/2007

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