Provider Demographics
NPI:1538557285
Name:ABUDULAHIM, BAHARNESH
Entity type:Individual
Prefix:
First Name:BAHARNESH
Middle Name:
Last Name:ABUDULAHIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-5571
Mailing Address - Country:US
Mailing Address - Phone:240-701-3433
Mailing Address - Fax:
Practice Address - Street 1:7600 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-5571
Practice Address - Country:US
Practice Address - Phone:240-701-3433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA134081469447172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker