Provider Demographics
NPI:1871906156
Name:MANOOCHEHRI, AMIR
Entity type:Individual
Prefix:DR
First Name:AMIR
Middle Name:
Last Name:MANOOCHEHRI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 EASTERN AVE
Mailing Address - Street 2:MFL WEST TOWER, 6TH FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-2734
Mailing Address - Country:US
Mailing Address - Phone:240-994-1082
Mailing Address - Fax:410-550-2972
Practice Address - Street 1:22 S GREENE ST RM N3E09
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-6110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD83740208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist