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1780814392

NPI Code Detail

MEDICARE: MITRA SAHEBAZAMANI MD

MEDICARE: MITRA SAHEBAZAMANI MD

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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	01087805B	IN
2	207RP1001X	Pulmonary Disease Physician	2018-02078	NC
3	174400000X	Specialist	305532	VA
4	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	0101246269	VA
5	208M00000X	Hospitalist Physician	0101246269	VA
6	1835C0205X	Critical Care Pharmacist	C194975	CA
7	207RP1001X	Pulmonary Disease Physician	C194975	CA
8	207R00000X	Internal Medicine Physician	C194975	CA
9	207RP1001X	Pulmonary Disease Physician	0101246269	VA
10	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	01087805A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	NN4574B	OTHER	NC	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	19YH6	OTHER	NC	BCBS OF NC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780814392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITRA SAHEBAZAMANI MD

Provider Business Mailing Address
First Line	:	PO BOX 780125
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19178-0125
Country	:	US
Telephone Number	:	804-922-4844
Fax Number	:

Provider Business Practice Location Address
First Line	:	1755 N MECKLENBURG AVE
Second Line	:
City	:	SOUTH HILL
State	:	VA
Zip	:	23970-4080
Country	:	US
Telephone Number	:	434-447-3151
Fax Number	:

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

Provider Enumeration Date	:	07/16/2009
Last Update Date	:	03/11/2026

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Directions to “ MITRA SAHEBAZAMANI MD” Practice Location

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