Provider Demographics
NPI:1609072578
Name:PIROUZ, BABAK SALEHI (MD)
Entity type:Individual
Prefix:DR
First Name:BABAK
Middle Name:SALEHI
Last Name:PIROUZ
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:PO BOX 791372
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-1372
Mailing Address - Country:US
Mailing Address - Phone:301-608-8375
Mailing Address - Fax:301-608-3979
Practice Address - Street 1:1648 HUNTINGDON PIKE
Practice Address - Street 2:
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8001
Practice Address - Country:US
Practice Address - Phone:215-947-3000
Practice Address - Fax:215-938-3829
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0066264207R00000X
VA0101255457207R00000X, 208M00000X
PAMD449461207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD413264500Medicaid
MD415096100Medicaid
DC132346Medicare PIN
VAVVK734B288Medicare PIN
MD413264500Medicaid