Provider Demographics
NPI:1447286612
Name:BAHRO, ABDUL G (MD)
Entity type:Individual
Prefix:
First Name:ABDUL
Middle Name:G
Last Name:BAHRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 N FLOWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9533
Mailing Address - Country:US
Mailing Address - Phone:601-487-7445
Mailing Address - Fax:601-487-7446
Practice Address - Street 1:1031 N FLOWOOD DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9533
Practice Address - Country:US
Practice Address - Phone:601-487-7445
Practice Address - Fax:601-487-7446
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16080207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1543012Medicaid
MS7580087OtherAETNA
MS00120721Medicaid
LA$$$$$$$$$DOtherBCBS
MS00120721Medicaid
LA1543012Medicaid
LA5A848C933Medicare PIN
MS7580087OtherAETNA
MS060062366Medicare PIN