Provider Demographics
NPI:1154389138
Name:BAHL, VIVEK (MD)
Entity type:Individual
Prefix:DR
First Name:VIVEK
Middle Name:
Last Name:BAHL
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 1:8116 GOOD LUCK RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3502
Mailing Address - Country:US
Mailing Address - Phone:301-552-1200
Mailing Address - Fax:301-552-1202
Practice Address - Street 1:8116 GOOD LUCK RD STE 305
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3508
Practice Address - Country:US
Practice Address - Phone:301-552-1200
Practice Address - Fax:301-552-1202
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101230081207RC0000X, 207RI0011X
DCMD33689207RC0000X, 207RI0011X
MDD0057926207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD412107400Medicaid
I69129Medicare UPIN
MD412107400Medicaid
DC126498ZA7TMedicare PIN